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Aggressive necrotizing pseudomonal sinonasal infections.

Authors :
Kuan, Edward C.
Tajudeen, Bobby A.
Welch, Kevin C.
Chandra, Rakesh K.
Glasgow, Ben J.
Suh, Jeffrey D.
Source :
International Forum of Allergy & Rhinology. Sep2017, Vol. 7 Issue 9, p910-915. 6p.
Publication Year :
2017

Abstract

Background Pseudomonas aeruginosa is a gram-negative bacterium frequently implicated in recalcitrant sinonasal infections, especially in immunocompromised hosts. We report 6 cases of rapidly progressive pseudomonal acute rhinosinusitis producing tissue necrosis and, in certain cases, cranial nerve palsies. Methods Retrospective review of 6 patients with aggressive necrotizing sinonasal infections treated at 4 tertiary academic medical centers with sinonasal cultures growing P. aeruginosa in the absence of other pathology. Results A total of 6 patients were identified. In all cases, there was tissue necrosis that appeared to mimic an invasive process such as mucormycosis, prompting urgent surgical intervention. Pathologic analysis revealed fibropurulent exudates in backgrounds of positive P. aeruginosa cultures without evidence of invasive fungal organisms or malignancy. Four of the 6 patients presented with cranial nerve palsies, with 3 patients having vision changes and 3 complaining of trigeminal neuropathy. Four of 6 patients improved clinically over time after surgery and antibiotic therapy; 1 remains in follow-up without complete improvement and 1 has succumbed to other causes. Conclusion P. aeruginosa is a tenacious organism that is frequently associated with severe, recalcitrant sinonasal infections. We report the first case series of necrotizing sinonasal infections caused by this organism, and illustrate that, in rare cases, P. aeruginosa may mimic and behave like life-threatening conditions such as fulminant invasive fungal sinusitis or malignancy. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
20426976
Volume :
7
Issue :
9
Database :
Academic Search Index
Journal :
International Forum of Allergy & Rhinology
Publication Type :
Academic Journal
Accession number :
125011776
Full Text :
https://doi.org/10.1002/alr.21981