A Nonsporulating Sinonasal Culprit

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ID: 320245
2026
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Ranked #531 of 532 articles by views in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Abstract
A 59-year-old stockbroker presented with recurrent episodes of supraorbital throbbing headache for the past 1 month. He had experienced 4 prior episodes of optic neuritis in the last 4 years, each demonstrating significant improvement with high-dose intravenous corticosteroid treatment. In between the episodes, he was on tapering doses of oral corticosteroids and mycophenolate mofetil for a working diagnosis of chronic relapsing inflammatory optic neuropathy. His past history was notable for bronchial asthma and a previous right frontal craniotomy for colloid cyst removal. During his current admission, he was diagnosed with diabetes mellitus with an HbA1c of 6.81%. Noncontrast computed tomography of the brain and paranasal sinuses demonstrated expansile spheno-ethmoidal lesions (Figures 1 and 2). Visualization of the nasal cavity during functional endoscopic sinus surgery (FESS) revealed abundant thick mucus. Lactophenol cotton blue mount (Figure 3) and direct fluorescent potassium hydroxide examination (Figure 4) demonstrated septate fungal hyphae with clamp connections and spicules. Fungal culture grew a white fluffy mold on Sabouraud dextrose agar, without sporulation. Histopathology showed eosinophil-rich mucin with scattered septate fungal hyphae without tissue invasion. Sequencing of the internal transcribed spacer region established the fungal identity. The patient improved after surgical debridement and intranasal corticosteroids.
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Authors Sandeep Rao Kordcal, Bhuvaneshwari Sakthivel, Angitha K P, Prem Thilak Palani, Heet Manvar, Gagandeep Singh, Immaculata Xess
Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2026
DOI
10.1093/cid/ciag374
URL
https://doi.org/10.1093/cid/ciag374
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