An uncommon cause of allergic fungal sinusitis: Rhizopus oryzae

We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis...

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Bibliographic Details
Published in:Ear, nose, & throat journal nose, & throat journal, 2015-01, Vol.94 (1), p.E17-E20
Main Authors: Devars du Mayne, Marie, Gratacap, Maxime, Malinvaud, David, Grenouillet, Frederic, Bonfils, Pierre
Format: Article
Language:English
Subjects:
Adult
Female
Humans
Life Sciences
Microbiology and Parasitology
Mucormycosis - complications
Mucormycosis - microbiology
Mycology
Nasal Polyps - microbiology
Rhinitis, Allergic - microbiology
Rhizopus
Sinusitis - microbiology
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Summary:We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis and bone erosion. T2-weighted magnetic resonance imaging demonstrated a signal void that suggested the presence of a fungal infection. The patient underwent unilateral ethmoidectomy. Histologic examination of the diseased tissue identified allergic mucin with 70% eosinophils and no fungal hyphae. Mycologic culture detected R oryzae. After a short period of improvement, the patient experienced a recurrence, which was confirmed by radiology. A second surgery was performed, and the same fungal hyphae were found in the mucus and on culture, which led us to suspect AFRS. Since no IgE test for R oryzae was available, we developed a specific immunologic assay that confirmed the presence of specific IgG, which identified a high degree of immunologic reaction against our homemade R oryzae antigens. With a long course of systemic antifungal treatment, the patient's symptoms resolved and no recurrence was noted at 5 years of follow-up.
ISSN:0145-5613
1942-7522