2026 Poster Presentations
P014: RARE CASE OF LASIODIPLODIA VITIS INVASIVE FUNGAL SINUSITIS AND ROLE FOR PCR TESTING
Logan F McColl, MD, MBA; Eric Nisenbaum, MD, MSc; Kyle VanKoevering, MD; The Ohio State University Wexner Medical Center
Background: Invasive fungal sinusitis (IFS) is most commonly attributed to Aspergillus species and fungi in the Mucorales order. These aggressive infections are almost exclusively seen in immunocompromised patients with diagnosis traditionally reliant on tissue samples with Gomori Methenamine Silver (GMS) staining. Presented here is an extremely rare case report of IFS due to Lasiodiplodia vitis, requiring universal polymerase chain reaction (PCR) testing for accurate species identification.
Case Description: A 38-year-old female with a history of myelofibrosis, 300 days post-allogeneic hematopoietic stem cell transplant on tacrolimus and methotrexate, developed progressive left-sided facial swelling despite multiple courses of amoxicillin-clavulanate for presumed sinusitis. She presented with severe neutropenia (absolute neutrophil count of 0). Otorhinolaryngology was consulted in her care and nasal endoscopic examination demonstrated left-sided purulence, left middle turbinate edema, and intact sensation without frank mucosal lesion(s) or discoloration. There were no cranial nerve deficits, ocular abnormalities, and/or skin lesions on physical examination. Computed Tomography and Magnetic Resonance Imaging of the paranasal sinuses demonstrated left worse than right-sided pansinusitis without evidence of orbital or significant soft tissue abnormalities.
Endoscopic sinus surgery with biopsies revealed left-sided sinonasal and nasopharyngeal edema. Frozen biopsies and multiple sets of bacterial, fungal, and acid-fast cultures were all negative. However, permanent pathology demonstrated fungal hyphae in 2 of 6 samples on GMS staining with morphology inconsistent with typical Mucorales or Aspergillus species. The patient was started on amphotericin B infusions and amphotericin irrigations. Empirical amphotericin B (intravenous and irrigation) was initiated. Universal fungal PCR identified Lasiodiplodia vitis.
The patient underwent five total endoscopic procedures over 2.5 months with progressive tissue improvement and GMS clearance. Antifungal therapy was successfully narrowed to voriconazole monotherapy after one month. Complete disease clearance was achieved with full clinical recovery.
Discussion: This case represents the first documented human infection by Lasiodiplodia vitis, a plant pathogen primarily known for causing Botryosphaeria dieback in grapevines. Previous literature documents only three cases of invasive fungal sinusitis caused by Lasiodiplodia theobromae, with L. vitis having no prior reports of human pathogenicity despite extensive agricultural exposure worldwide.
The Lasiodiplodia genus belongs to the dematiaceous fungi family, typically environmental saprophytes found in tropical and subtropical soils. While L. theobromae has emerged as an opportunistic human pathogen causing predominantly keratitis (79 documented cases) and rarely invasive infections, L. vitis represents a novel human pathogen with unknown virulence mechanisms and treatment responses.
This case highlights critical diagnostic limitations of conventional methods. GMS staining failed to provide accurate specific species identification crucial for targeted therapy. The atypical hyphal morphology necessitated molecular diagnostics, emphasizing the role of PCR sequencing in contemporary fungal diagnostics, particularly for rare pathogens.
The successful treatment with surgical debridement of affected tissues and amphotericin B followed by voriconazole, based on fungal susceptibility testing, suggests a similar treatment and susceptibility pattern to L. theobromae. This case expands our understanding of Botryosphaeriaceae pathogenic potential and underscores the need for molecular diagnostics in atypical presentations of invasive fungal disease.