Reactions 1680, p31 - 2 Dec 2017 Amoxicillin/clavulanic-acid/ corticosteroids Fungal rhinosinustis presenting as bell’s palsy: case report A 73-year-old man developed fungal rhinosinusitis, which presented as Bell’s palsy following treatment with prednisolone, amoxicillin/clavulanic-acid and intranasal corticosteroids [specific drugs not stated;durations of treatments to reactions onsets not stated; not all routes stated]. The man had a history of type 2 diabetes mellitus. He underwent liver and renal transplant in 2004 and 2008 respectively. He received prednisolone 5 mg/day and other medications for maintenance immunosuppression. In 2014, he reported symptoms of sinusitis and was prescribed amoxicillin/clavulanic-acid 375mg thrice daily for one week, nasal irrigation and intranasal corticosteroids. Intranasal corticosteroids were intermittently continued as per recurrence of symptoms. He presented with right ear pain and sudden onset of right-sided facial palsy after six months. Physical examination revealed right cranial nerve VII palsy. He was diagnosed with Bell’s palsy. The man was administered prednisolone for one week. An MRI of brain showed otitis media, right mastoid effusion, maxillary sinusitis and superior sagittal sinus thrombosis. A fungal ball lesion was diagnosed through maxillary sinus antrostomy and right myringotomy. Histology showed fungal hyphae with leucocyte infiltrates. Aspergillus species was identified via internal transcribed spacer sequencing. He underwent sinus debridement twice followed by treatment with anidulafungin and voriconazole. His sinusitis was still evident in interval imaging while he showed complete resolution of the cranial nerve palsy [not all outcomes stated]. Author comment: "Invasive fungal infection is relatively uncommon in kidney transplant recipients. . .Common risk factors include diabetes mellitus, high-dose corticosteroid therapy, recent or prolonged antibiotic use". "Whether the prior course of antibiotics and prolonged use of intranasal corticosteroid inhalation might have precipitated the fungal infection, or the latter had been present from the start when the patient presented with sinusitis remained speculative." Mok MMY, et al. Invasive fungal rhinosinusitis presenting as Bell’s palsy in a kidney and liver transplant recipient. Journal of the Formosan Medical Association 116: 910-911, No. 11, Nov 2017. Available from: URL: http://doi.org/10.1016/ j.jfma.2017.04.012 - Hong Kong 803285116 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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