Invasive sinus aspergillosis with acute myeloid leukemia: A case report

Invasive fungal sinusitis is still a life-threatening infection in immunocompromised patients. Its onset is rapid and leads to severe complications. We describe a neutropenic patient with acute myeloid leukemia who developed invasive sinus aspergillosis despite receiving prophylactic itraconazole and empirical micafungin. The patient demonstrated apparent clinical findings such as nasal discharge, nasal congestion, and skin and mucosal necrosis. Computer tomography scans strongly demonstrated invasive maxillary sinusitis. Serological examinations for (1-3)-β-d-glucan and Aspergillus galactomannan antigen were positive, suggesting Aspergillus infection. The diagnosis of invasive sinus aspergillosis was confirmed by in situ hybridization using Aspergillus-specific probe in formalin-fixed, paraffin-embedded tissue samples. The causative organism was identified as Aspergillus fumigatus by fungal culture. Despite surgical treatment with drainage and intensive antifungal administration of voriconazole and liposomal amphotericin B, the infection rapidly disseminated to the lungs, resulting in a fatal progression of the condition.