Necrotizing Pseudomonal Sinusitis in a Transplant Patient

Necrotizing pseudomonal sinusitis is a rare disease that can be clinically identical to invasive fungal sinusitis (IFS). Early differentiation between these two etiologies is crucial, as the treatment algorithms are distinct. Here, we present a report of necrotizing pseudomonal sinusitis in a solid organ transplant patient and propose an appropriate treatment strategy for this disease. A 65-year-old lung transplant patient developed a <i>Pseudomonas</i> bacteremia, followed by symptoms of a severe, complicated sinusitis that included a trigeminal neuropathy. Imaging showed extension of disease outside the sinonasal cavities, involving the periorbital and periantral spaces. The patient was treated with emergent surgical debridement confined to the sinonasal cavities. This was followed by long-term, focused systemic and topical antipseudomonal therapy, as well as modification of the patient's immunosuppressive regimen, resulting in full resolution of the patient's pseudomonal infection. Otolaryngologists, as well as transplant practitioners, should be aware of this rare, potentially fatal disease that so closely mimics IFS.