CANDIDA GLABRATA - CHRONIC SINUSITIS IN AN IMMUNOCOMPETENT PATIENT

Ano: 2013 | Volume: 17 | Número: Suplemento

Autores: Ferreira PG, Junior ACV, Mendes DL, Carvalho LS, Raddi M, Nascimento NS, et al.

Resumo Inglês:

Studies have shown that the diagnosis of chronic rhinosinusitis caused by fungi is increasing. Traditionally, it is believed that the population most susceptible to this infection is the immunosuppressed; however, we report a rare case of rhinosinusitis caused by Candida glabrata in an immunocompetent patient. A. P. S., a 19-year-old woman, visited the ambulatory otolaryngology clinic at Marcilio Dias Navy Hospital for assessment in April 2012, complaining of nasal obstruction, hyposmia, and thick, yellowish rhinorrhea. She reported that these symptoms had persisted for 5 years with no improvement, even after several treatments for rhinitis. The investigation of the patient's symptoms began by acquiring a computed tomography (CT) scan of the sinuses, which showed subtotal, bilateral opacification of the maxillary sinuses, and the septum deviating to the left. Functional endoscopic sinus surgery was indicated, which was performed in December 2012. During the antrostomy, lumpy, yellowish secretions were found in both sinuses, requiring access using the Caldwell-Luc approach for a complete, bilateral cleaning of the maxillary sinuses. Growth of Candida glabrata was observed in a culture for fungi, which led us to investigate immunodeficiency, but with negative results. A major obstacle in Candida glabrata infections is their innate resistance to azole antimycotic therapy; therefore, it was necessary to prescribe caspofungin treatment for 15 days. In January 2013, a new puncture was made in the maxillary sinuses to control the patient's healing. There was no growth of Candida glabrata in culture. Chronic, fungal sinusitis should be considered as a diagnosis in immunocompetent as well as immunosuppressed patients.