Rhinosinusitis Complicated by Scedosporium Sp. in a Patient With Decompensated Diabetes: a Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Infections caused by fungi of the genus Scedosporium range from superficial conditions to invasive and severe disease in immunocompromised patients, commonly those with diabetes and/or cancer. Due to airway colonization, the most frequently involved sites in invasive disease are the lungs, paranasal sinuses, eyes, and central nervous system. A 70-year-old man with hypertension and poorly controlled diabetes mellitus (admission glycated hemoglobin: 13.3%) presented with facial pain, unilateral nasal congestion, and malaise for two months, associated with hyporexia and a consumptive syndrome (reported weight loss of 20 kg during this period). He had previously sought medical care and received antimicrobial therapy without improvement. He was transferred to a tertiary care center for specialized evaluation. On admission, symptoms persisted, with additional visual blurring, diplopia, and confusion. Physical examination revealed left eye ophthalmoplegia with amaurosis, eyelid ptosis, and ipsilateral proptosis. Imaging studies confirmed orbital apex syndrome and left central retinal artery occlusion. The patient underwent bilateral sphenoidectomy and left posterior ethmoidectomy, and intravenous voriconazole was initiated. Cerebrospinal fluid collected during surgery showed mild pleocytosis (11 cells/mm³) with polymorphonuclear predominance, protein level of 71.1 mg/dL, and glucose of 152 mg/dL (simultaneous serum glucose 471 mg/dL). Neurological status did not improve despite treatment, and the patient progressed with decreased level of consciousness requiring intubation. Biopsy showed acute and chronic mucosal inflammation, partially granulomatous with multinucleated giant cells and epithelioid macrophages, and structures compatible with broad, relatively regular hyphae, with no signs of malignancy. Liposomal amphotericin B was added in an attempt to enhance treatment. The patient developed hepatic and renal dysfunction and nosocomial infectious complications, progressing to death after 60 days of hospitalization. Given the intrinsic antifungal resistance of this pathogen and the associated comorbidities, these cases are difficult to diagnose and manage therapeutically, even with timely surgical intervention.
Institution: Universidade Federal de Uberlândia
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,600
OpenAlex ID: W7135417883
FWCI:
Cites:
Cited by:
Related to: