Korean J Hematol.  2005 Sep;40(3):205-209. 10.5045/kjh.2005.40.3.205.

A Case of Invasive Maxillary and Orbital Aspergillosis Inhematopoietic Stem Cell Transplantation Recipient with Severe Aplastic Anemia

• Joo YD
• Lee WS
• Kim JL
• Yang JW
• Kim HW
• Park SK
• Sohn CH

• KMID: 1610819
• DOI: http://doi.org/10.5045/kjh.2005.40.3.205

Abstract

Invasive aspergillosis (IA) of the paranasal sinuses is a rare infectious complication associated with allogeneic hematopoietic stem cell transplantation (HSCT). However, immunocompromised patients are particularly at risk of fulminant IA. The high risk of an invasive fungal infection (IFI) following allogeneic HSCT is due to several factors, including neutropenia before engraftment, disruption of mucosal barriers by various preparative regimens and the use of broad-spectrum antimicrobial agents, as well as the immunosuppressive effects of prophylaxis and treatment of GVHD. As the therapy for an IFI following allogeneic HSCT is often unsuccessful, the mortality rate is increased by 95%. Therefore, early diagnosis is important to overcome the high mortality of this destructive disease. In previous studies, high risks for the early onset of IA were demonstrated in patients with severe aplastic anemia (SAA), independent of the day of engraftment. Here, we report a case of invasive aspergillosis of the maxillary sinuses and orbit in a 50 years old man with SAA, who underwent an allogeneic HSCT from a HLA-matched sibling conditioned with Cytoxan/Fludara/ATG.

Keyword

Maxillary sinus; Orbit; Aspergillosis; Severe aplastic anemia; Allogeneic hematopoietic stem cell transplantation

MeSH Terms

Anemia, Aplastic*
Anti-Infective Agents
Aspergillosis*
Early Diagnosis
Hematopoietic Stem Cell Transplantation
Humans
Immunocompromised Host
Maxillary Sinus
Middle Aged
Mortality
Neutropenia
Orbit*
Paranasal Sinuses
Siblings
Stem Cell Transplantation*
Stem Cells*
Anti-Infective Agents

Figure

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  Fig. 1. The gross appearance of the patient showed a slight left exophthalmos, protrusion of lower conjunctival mucosa, left periorbital and cheek swelling.

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  Fig. 2. Endoscopic findings of left maxillary sinus showed brownish white discoloration and edematous necrotic mucosa which were suggestive findings of fungal infection.

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  Fig. 3. Computed tomography scan showed left maxillary and frontoethmoid sinus inflammation with extension into inferior part of left orbit.

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  Fig. 4. Histologic examination of surgical specimens showed abundant neutrophilic fibrinoid exudative material containing Aspergillus hyphae which was broad, septate, and branch at about 45° (Gomori Metanamine Silver stain, original magnification ×400).

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