Contributed by Teresa LaCaria, M.D. and William Pasculle, ScD.
The patient is a 20-year-old male diagnosed with autoimmune hepatitis who subsequently developed aplastic anemia. He was hospitalized for immunosuppressive therapy and evaluation for possible bone marrow transplant. The patient remained markedly leukopenic with white blood cell counts as low as 200/cu mm with 4% neutrophils. Approximately three weeks after admission, he developed fever with pain in the left maxillary region, facial swelling, and gingival bleeding. Computed tomography demonstrated left paranasal sinus opacification, periapical lucency surrounding the left premolar/molar teeth, cellulitis of the left buccal and masseteric regions, and subtle retromaxillary fat obscuration. No abscess or osteomyelitis was noted. Blood cultures were persistently negative. The patient underwent sinonasal surgery for tissue debridement, including a left middle partial turbinectomy, total ethmoidectomy, and partial septectomy. Histologic sections of the nasal septum and turbinate showed numerous fungal hyphae and conidia with tissue invasion [Figures 1, 2, 3, 4, 5, 6 and 7]. Cultures from the turbinate tissue were performed.