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Aggressive necrotizing pseudomonal sinonasal infections
Author(s) -
Kuan Edward C.,
Tajudeen Bobby A.,
Welch Kevin C.,
Chandra Rakesh K.,
Glasgow Ben J.,
Suh Jeffrey D.
Publication year - 2017
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21981
Subject(s) - medicine , fulminant , mucormycosis , malignancy , pseudomonas aeruginosa , sinusitis , antibiotics , dermatology , surgery , pathology , microbiology and biotechnology , bacteria , biology , genetics
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.