Fulminant Drechslera sinusitis in an immunocompetent host.
Mycotic infections of the paranasal sinuses are rare. Sinusitis caused by Drechslera spicifera, a common saprophytic dematiacious fungus, has previously been reported in only three immunocompetent patients. Aggressive growth characteristics were not described in any of these reports. The case of a young immunocompetent pregnant woman with fulminant sinusitis caused by Drechslera spicifera is presented. The tumor, which invaded both orbits and the anterior cranial fossa, was rapidly progressive during pregnancy. After delivery of the baby, a combined craniofacial approach was used to excise the sinus mass while adjacent normal tissues were preserved. The pathophysiology and mycology of this uncommon sinus pathogen are reviewed. This case emphasizes the need for prompt surgical intervention to avoid potentially life-threatening complications from a fulminant mycotic process in the paranasal sinuses. Indications for postoperative chemotherapy with amphotericin B are discussed.