Rhinosinusitis is an inflammation of the nasal mucosa and paranasal sinuses, of infectious or noninfectious origin, and may be acute or chronic. Fungal forms are more frequent in immunosuppressed individuals but can also affect immunocompetent patients. Chronic disease caused by Candida pelliculosa and Cladosporium sp. may result from inhalation of environmental spores, followed by mucosal colonization and activation of an inflammatory response. Candida pelliculosa is an opportunistic yeast rarely associated with human infections, while Cladosporium sp. are saprophytic fungi that may act as pathogens in susceptible hosts. We report the case of a 47-year-old immunocompetent woman, overweight, with a history of bilateral hearing loss and decreased visual acuity related to an undiagnosed polyneuropathy, who presented with recurrent rhinosinusitis for approximately two years, unresponsive to prolonged antibiotic and corticosteroid therapy. She developed nasal deformity (saddle nose), progressive obstruction, dark crusts, rhinorrhea, and recurrent fever. Rheumatologic investigation ruled out autoimmune disease. CT imaging showed chronic pansinusitis, probable polyps, obstruction of drainage pathways, and bone osteopenia. She underwent nasal debridement surgery, and cultures grew Candida pelliculosa sensitive to fluconazole. She was treated with fluconazole 300 mg/day for six months, with partial improvement. A second surgery and culture revealed Cladosporium sp., and itraconazole 200 mg/day was initiated for six weeks, with good response. Three months after completing antifungal therapy, reevaluation showed absence of secretion and complete resolution of inflammatory signs, with negative cultures, indicating infection resolution. In prolonged or recurrent rhinosinusitis, even in the absence of defined immunosuppression, fungal etiology should be suspected to guide appropriate diagnostic and therapeutic strategies, prevent sequelae, and improve quality of life.
Vieira et al. (Sun,) studied this question.