Scedosporium Apiospermum: Fungal Sinusitis in an Immunocompetent Patient

Scedosporium apiospermum (also known as Pseudallescheria boydii) is a well-recognized cause of mycetoma and, more recently, pulmonary fungomas. We describe the sixth occurrence of S. apiospermum sinusitis in an otherwise healthy adult. This patient is unique in her history of invasive fungal disease. She initially underwent transseptal sphenoidotomy for presumed aspergillosis and had no other therapy. She did well but 14 months later developed recurrent symptoms. Examination revealed fungal mycelium protruding through the surgically enlarged sphenoid ostium. An endoscopic approach was used to remove the fungoma and strip the sphenoid mucosa. Cultures grew S. apiospermum as well as Serratia liquefasciens. No invasion was seen on pathology. Postoperatively, the patient received ciprofloxacin. This patient has been observed for 11 months and shows no evidence of infection. Previous approaches to treatment have included primarily surgical debridement. Antifungal chemotherapy has been added only to patients who clearly demonstrated invasion or patients with immune compromise. This represents the first report of this pathogen in which an endoscopic approach was used.