DIFFICULT DIAGNOSIS AND MANAGEMENT OF FUNGAL INJURY

Abstract

A 56-year-old smoker had asymptomatic lesions on the hard palate and reported osteopenia, asthma, and chronic allergic rhinitis with "odors" and continued use of bronchodilators and antiallergics. Initial treatment was nystatin oral solution for 15 days and subsequent incisional biopsy for histopathologic and mycological evaluation. The histopathologic report pointed to infection by fungal agent–producing sporangia and endospores, being a case of difficult diagnosis because of the rarity of the infection, suggesting the possibility of rhinosporidiosis, but the mycological report did not observe fungal structures in the sample. The patient opted for systemic antifungal treatment with itraconazole (Sporanox (Janssen-Cilag)) rather than the surgical treatment of choice. After 6 months the lesion did not regress, corroborating with the literature, which shows that the systemic treatment for this type of lesion is not ineffective. Surgical resection becomes necessary for resolution of the condition. A 56-year-old smoker had asymptomatic lesions on the hard palate and reported osteopenia, asthma, and chronic allergic rhinitis with "odors" and continued use of bronchodilators and antiallergics. Initial treatment was nystatin oral solution for 15 days and subsequent incisional biopsy for histopathologic and mycological evaluation. The histopathologic report pointed to infection by fungal agent–producing sporangia and endospores, being a case of difficult diagnosis because of the rarity of the infection, suggesting the possibility of rhinosporidiosis, but the mycological report did not observe fungal structures in the sample. The patient opted for systemic antifungal treatment with itraconazole (Sporanox (Janssen-Cilag)) rather than the surgical treatment of choice. After 6 months the lesion did not regress, corroborating with the literature, which shows that the systemic treatment for this type of lesion is not ineffective. Surgical resection becomes necessary for resolution of the condition.