Journal of Fungi (Aug 2022)

Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by <i>Alternaria</i><i>alternata</i> in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review

  • Giorgos Tyrellis,
  • Maria Siopi,
  • Danai Leventakou,
  • Alexander Delides,
  • Pavlos Maragkoudakis,
  • George Korres,
  • Christina Apostolopoulou,
  • Alina-Roxani Gouloumi,
  • Vasiliki Pappa,
  • Spyros Pournaras,
  • Ioannis Panayiotides,
  • Joseph Meletiadis

DOI
https://doi.org/10.3390/jof8080879
Journal volume & issue
Vol. 8, no. 8
p. 879

Abstract

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Alternaria spp. have emerged as opportunistic pathogens particularly in immunosuppressed patients. A case of a breakthrough acute invasive fungal rhinosinusitis (AIFRS), caused by Alternaria alternata, is reported in a patient with acute lymphoblastic leukemia (ALL) on anidulafungin therapy, who was successfully treated with liposomal amphotericin B and surgical intervention. To date, 20 cases of AIFRS due to Alternaria spp. have been described, 19 in the USA and 1 in Chile, making this case report the first case of AIFRS due to Alternaria in Europe. The patients had median (range) age 25 (2–56) years (65% female), almost all of them (19/20) with hematological diseases and severe neutropenia (8–41 days pre-infection). Amphotericin B was the most frequently used antifungal agent, either alone or in combination. In all of the cases, systemic antifungal therapy was combined with surgery. Despite stabilization or improvement of the AIFRS, mortality was 38% (5 days to 8 months post-surgical debridement) due to their underlying disease or other infections without sign of AIFRS at autopsy.

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