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Saksenaea oblongispora Rhinosinusitis in Advanced HIV: A Rare and Lethal Mucormycosis

Summary

A 32-year-old man with advanced HIV developed a severe fungal infection of his sinuses caused by a rare fungus called Saksenaea oblongispora, which typically doesn’t affect people with HIV. The patient presented with severe facial swelling that rapidly worsened, and despite doctors identifying the fungus through biopsies and lab tests, he did not receive antifungal treatment or surgery before his condition became critical. This is the first case of this particular fungal infection documented in sub-Saharan Africa and in HIV patients, highlighting how dangerous this rare infection can be and how challenging it is to diagnose quickly enough to save lives.

Background

Mucormycosis is a severe invasive fungal infection caused by Mucorales fungi, commonly affecting immunocompromised individuals. Saksenaea oblongispora is a rare cause of mucormycosis that typically affects immunocompetent hosts following traumatic inoculation, accounting for approximately 3% of human mucormycosis cases. This case represents the first documented S. oblongispora infection in sub-Saharan Africa and in the setting of HIV infection.

Objective

To describe and document a case of rapidly progressing rhinosinusitis caused by S. oblongispora in a patient with advanced HIV infection (CD4 count <50 cells/μL). The case aims to highlight the diagnostic challenges and high mortality associated with this rare fungal infection in the immunocompromised setting.

Results

Fungal cultures identified S. oblongispora through molecular testing after phenotypic identification proved impossible. Histopathological examination revealed thick-walled angioinvasive fungal elements with evidence of angioinvasion in nasal and cheek biopsies. CT imaging showed complete opacification of the right maxillary sinus with involvement of ethmoid sinuses and facial cellulitis. The patient rapidly deteriorated without antifungal therapy or surgical intervention, dying 7 days after admission.

Conclusion

This case emphasizes the critical importance of maintaining high suspicion for invasive mold infections in immunocompromised patients and the necessity of combining multiple diagnostic platforms for timely identification. A multidisciplinary approach involving infectious disease specialists, otolaryngologists, microbiologists, and pathologists is essential for optimal management. Despite rapid diagnosis and appropriate testing, the prognosis of mucormycosis remains poor, with high mortality rates even with aggressive intervention.
  • Published in:Case Reports in Pathology,
  • Study Type:Case Report,
  • Source: PMID: 40861428, DOI: 10.1155/crip/3227863
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