Case of the Month - August 2019
A 45 year old man with chronic rhinosinusitis and nasal polyps had a second endoscopic sinus operation in December 2018. He had persistent intermittent post-nasal drainage several months after the surgery, and a loss of his sense of smell. He underwent multiple rounds of endoscopically directed antibiotic instillations which resulted in some improvement. However, he described a return of symptoms in a follow-up visit. A rigid nasal bronchoscopy showed deterioration of his sino-nasal appearance. Findings included thick crusting, mucopurulence, mucin, soft tissue swelling, and polyps bilaterally. A bacterial culture was positive for Pseudomonas aeruginosa, and the organisms shown in Figure 1, 2 and 3 grew from fungal cultures.
Name the three fungi.
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Figure 1a: Sabouraud dextrose agar plate showing growth of the first isolate.
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Figure 1b: lactophenol cotton blue stain of the first isolate (1000X).
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Figure 2a: Sabouraud dextrose agar plate showing growth of the second isolate.
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Figure 2b: lactophenol cotton blue stain of the second isolate (1000X).
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Figure 3: Gram stain of the third isolate (1000X).