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Case Report: Invasive Sinusitis due to Sporothrix Brasiliensis in a Renal Transplant Recipient
ABSTRACT.
Sporotrichosis is usually a subcutaneous infection caused by thermodimorphic fungi of the genus Sporothrix. The disease occurs worldwide, but endemic areas are located in tropical and subtropical regions. The epidemiology of sporotrichosis in Brazil is peculiar because of the cat’s entry in the chain of transmission of this mycosis, associated with Sporothrix brasiliensis, the most virulent species in the genus. Sinusitis caused by Sporothrix species is unusual and may be underdiagnosed or confused with other fungal etiologies, like mucormycosis. We report a case of sinusitis due to a Sporothrix species in a 6-year renal transplant recipient. Direct examination of smears of exudate of the sinus specimen (aspirate, biopsy) revealed budding yeasts and cigar-shaped cells. Sporothrix was subsequently recovered from the patient’s exudate culture and identified as S. brasiliensis using species-specific polymerase chain reaction, and she was successfully treated with antifungal therapy. Her parents also developed the disease a week later, both only cutaneous involvement. Sporotrichosis sinusitis is a rare disease, even in immunocompromised patients. Diagnosis is crucial, and benefits from good epidemiological history.
Author Notes
Disclosure: A. M. R. was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (2017/27265-5), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq 433276/2018-5 and 304902/2020-9).
Authors’ addresses: Maria Júlia Correia Lima Nepomuceno Araújo, Camila Hitome Nihei, Maria Alice Barcellos, Osni Braga, and Irene Faria Duayer, Hospital 9 de Julho, Nephrology, Sao Paulo, Brazil, E-mails: maju_araujo@yahoo.com.br, cnihei@gmail.com, alicebarcelos@uol.com.br, osbra@terra.com.br, and ireneduayer@gmail.com. Hermes Higashino, Vinicius Ponzio, and Antonio Carlos Campos Pignatari, Hospital 9 de Julho, Infectious diseases, Sao Paulo, Brazil, E-mails: hermesrh@gmail.com, viponzio@gmail.com, and pignatari@terra.com.br. Anderson Messias Rodrigues, Federal University of São Paulo, Microbiology, Immunology and Parasitology, São Paulo, Brazil, E-mail: amrodrigues.amr@gmail.com.