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Rhino sinusitis caused by Lasiodiplodia theobromae in a diabetic patient

Summary

A 56-year-old diabetic man developed a sinus infection caused by a rare fungus called Lasiodiplodia theobromae, which typically affects plants. The infection was diagnosed through laboratory testing and DNA sequencing, as traditional identification methods were inconclusive. The patient was successfully treated with a combination of sinus surgery and a six-week course of antifungal medication, showing complete recovery after one year of follow-up.

Background

Lasiodiplodia theobromae is a dematiaceous fungus primarily known as a plant pathogen causing fruit and plant rot in tropical and subtropical regions. Human infections are uncommon, with only a few reported cases in the literature, though the fungus has been associated with various clinical manifestations including onychomycosis, corneal ulcers, and phaeohyphomycosis.

Objective

To report an uncommon case of rhinosinusitis caused by Lasiodiplodia theobromae in a diabetic patient and describe the diagnostic and therapeutic approach.

Results

Phenotypic identification revealed melanized hyphae with immature hyaline conidia and dark-walled septate conidia, but was inconclusive for genus and species. DNA sequencing confirmed the isolate as Lasiodiplodia theobromae. The patient was treated with surgical debridement and liposomal amphotericin B (5mg/kg/day for 6 weeks) and showed clinical improvement with imaging confirmation of lesion clearing at one-year follow-up.

Conclusion

Lasiodiplodia theobromae should be considered as a rare cause of fungal rhinosinusitis. A multimodality treatment approach combining surgical debridement with appropriate systemic and locally administered antifungal agents is necessary for successful management. Molecular methods are essential for accurate and rapid species identification of this challenging pathogen.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 36923660, DOI: 10.1016/j.mmcr.2023.02.002
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