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A Rare Case of Fungal Maxillary Sinusitis due to Paecilomyces lilacinus in an Immunocompetent Host, Presenting as a Subcutaneous Swelling.

Permi HS, Sunil KY, Karnaker VK, Kishan PH, Teerthanath S, Bhandary SK - J Lab Physicians (2011)

Bottom Line: Very rarely, it causes similar infection in immunocompetent host without any risk factors.We report a case of maxillary sinusitis due to Paecilomyces lilacinus in a 65-year-old immunocompetent male, who presented with a subcutaneous swelling below the left eye.After 1 year of follow up, he is free of symptoms with no evidence of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, India.

ABSTRACT
Paecilomyces is a colonizing fungal species which usually causes keratitis, endocarditis, sinusitis, nephritis, fungemia, cutaneous, and subcutaneous infections in immunocompromised host. Very rarely, it causes similar infection in immunocompetent host without any risk factors. We report a case of maxillary sinusitis due to Paecilomyces lilacinus in a 65-year-old immunocompetent male, who presented with a subcutaneous swelling below the left eye. The lesion was excised by surgery and treated with itraconazole for 6 months based on culture and sensitivity. After 1 year of follow up, he is free of symptoms with no evidence of recurrence.

No MeSH data available.


Related in: MedlinePlus

(a) Clinical image with left infraorbital swelling. (b) CT scan: paranasal sinuses showing well-defined rounded cystic lesion (shown with arrow) in the left infraorbital region, eroding the maxilla with focal thickening of left maxillary sinus mucosa
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Figure 1: (a) Clinical image with left infraorbital swelling. (b) CT scan: paranasal sinuses showing well-defined rounded cystic lesion (shown with arrow) in the left infraorbital region, eroding the maxilla with focal thickening of left maxillary sinus mucosa

Mentions: A 65-year-old male presented with painless swelling below the left eye [Figure 1(a)] since 10 months. The swelling was insidious in onset and gradually increased in size. There was no history of trauma, nasal obstruction, nasal discharge, and visual disturbance. On examination, left infra orbital swelling was nontender and cystic ms 2 × 2cm with mild left maxillary sinus tenderness. Clinical diagnosis of epidermal cyst with maxillary sinusitis was made. Hematological investigations revealed, hemoglobin – 13 gm/dl, total leucocyte count – 9600 cells/cumm, platelet count of 1,89,000 cells/cumm and erythrocyte sedimentation rate of 18 mm at the end of 1 h. Biochemical investigations showed random blood sugar – 98 mg/dl, blood urea - 38mg/dl, serum creatinine - 0.8mg/dl. Serology for HIV I and II by ELISA was negative. CT scan of paranasal sinuses showed well- defined rounded cystic lesion, ms 2.5 × 1.8cm in the subcutaneous tissue of the left infraorbital region, eroding the underlying bony orbital margin formed by the maxilla and focal thickening of left maxillary sinus mucosa [Figure 1(b)]. Excision of the left infraorbital cyst along with maxillary sinus clearance by Caldwell Luc's surgery was done.


A Rare Case of Fungal Maxillary Sinusitis due to Paecilomyces lilacinus in an Immunocompetent Host, Presenting as a Subcutaneous Swelling.

Permi HS, Sunil KY, Karnaker VK, Kishan PH, Teerthanath S, Bhandary SK - J Lab Physicians (2011)

(a) Clinical image with left infraorbital swelling. (b) CT scan: paranasal sinuses showing well-defined rounded cystic lesion (shown with arrow) in the left infraorbital region, eroding the maxilla with focal thickening of left maxillary sinus mucosa
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118058&req=5

Figure 1: (a) Clinical image with left infraorbital swelling. (b) CT scan: paranasal sinuses showing well-defined rounded cystic lesion (shown with arrow) in the left infraorbital region, eroding the maxilla with focal thickening of left maxillary sinus mucosa
Mentions: A 65-year-old male presented with painless swelling below the left eye [Figure 1(a)] since 10 months. The swelling was insidious in onset and gradually increased in size. There was no history of trauma, nasal obstruction, nasal discharge, and visual disturbance. On examination, left infra orbital swelling was nontender and cystic ms 2 × 2cm with mild left maxillary sinus tenderness. Clinical diagnosis of epidermal cyst with maxillary sinusitis was made. Hematological investigations revealed, hemoglobin – 13 gm/dl, total leucocyte count – 9600 cells/cumm, platelet count of 1,89,000 cells/cumm and erythrocyte sedimentation rate of 18 mm at the end of 1 h. Biochemical investigations showed random blood sugar – 98 mg/dl, blood urea - 38mg/dl, serum creatinine - 0.8mg/dl. Serology for HIV I and II by ELISA was negative. CT scan of paranasal sinuses showed well- defined rounded cystic lesion, ms 2.5 × 1.8cm in the subcutaneous tissue of the left infraorbital region, eroding the underlying bony orbital margin formed by the maxilla and focal thickening of left maxillary sinus mucosa [Figure 1(b)]. Excision of the left infraorbital cyst along with maxillary sinus clearance by Caldwell Luc's surgery was done.

Bottom Line: Very rarely, it causes similar infection in immunocompetent host without any risk factors.We report a case of maxillary sinusitis due to Paecilomyces lilacinus in a 65-year-old immunocompetent male, who presented with a subcutaneous swelling below the left eye.After 1 year of follow up, he is free of symptoms with no evidence of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, India.

ABSTRACT
Paecilomyces is a colonizing fungal species which usually causes keratitis, endocarditis, sinusitis, nephritis, fungemia, cutaneous, and subcutaneous infections in immunocompromised host. Very rarely, it causes similar infection in immunocompetent host without any risk factors. We report a case of maxillary sinusitis due to Paecilomyces lilacinus in a 65-year-old immunocompetent male, who presented with a subcutaneous swelling below the left eye. The lesion was excised by surgery and treated with itraconazole for 6 months based on culture and sensitivity. After 1 year of follow up, he is free of symptoms with no evidence of recurrence.

No MeSH data available.


Related in: MedlinePlus