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

Young Don Joo; Won Sik Lee; Jung Lim Kim; Jae Wook Yang; Hyun Woong Kim; Seang Kook Park; Chang Hak Sohn

doi:10.5045/kjh.2005.40.3.205

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Joo, Lee, Kim, Yang, Kim, Park, and Sohn: A Case of Invasive Maxillary and Orbital Aspergillosis lnhematopoietic Stem Cell Transplantation Recipient with Severe Aplastic Anemia

Case Report

Korean J Hematol 2005;40(3):205-209.

Published online: 21 September 2005

DOI: https://doi.org/10.5045/kjh.2005.40.3.205

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

Young Don Joo, M.D.¹, Won Sik Lee, M.D.¹, Jung Lim Kim, M.D.², Jae Wook Yang, M.D.², Hyun Woong Kim, M.D.², Seang Kook Park, M.D.³, Chang Hak Sohn, M.D.¹

¹Department of Internal Medicine, College of Medicine, Inje University, Busan, Korea

²Department of Ophrhalmology, College of Medicine, Inje University, Busan, Korea

³Department of Ororhinolaryngology, College of Medicine, Inje University, Busan, Korea

Correspondence co: Young Don Joo, M.D. Department of Internal Medicine, College of Medicine, Inje University 633-165 Goeguem-dong, Jin-gu, Busan 614-110, Korea Tel: +82-51-890-6076, Fax: +82-51-892-0273 E-mail: yjoo@inje.ac.kr

Received 8 July 2005 Revised 31 August 2005 Accepted 31 August 2005

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 mucosa! 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.

Keywords: Maxillary sinus, Orbit, Aspergillosis, Severe aplastic anemia, Allogeneic hematopoietic stem cell transplantation

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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.

Fig. 2.

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

Fig. 3.

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

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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