Attack of Rare Molds: Challenges of Infection With Thermothelomyces thermophilus in an Immunocompromised Host

Invasive fungal sinusitis (IFS) is a fungal infection of the paranasal sinuses that invades the surrounding tissues in a susceptible host, such as those with poorly controlled diabetes mellitus, profound neutropenia, advanced HIV, solid organ and stem cell transplant, recent chemotherapy, or corticosteroid use, with mortality rates of > 50% [ 1,2 ].The most common culprits are often Mucorales, Aspergillus spp., or Candida spp.[ 3 ].The initial nonspecific symptoms of headache and facial pain can delay diagnosis and treatment, which is associated with a poor prognosis [ 2 ].We present a case of a patient with neutropenia after undergoing stem cell transplant who developed acute IFS with a rare mold, Thermothelomyces thermophilus .A 74-year-old female with a history of post-polycythemia myelofibrosis presented to the hospital for a planned stem cell transplant.She was previously treated with ruxolitinib and received conditioning chemotherapy with fludarabine, cyclophosphamide, and total body irradiation.She was started on isavuconazole 372 mg daily, valacyclovir 500 mg twice daily, and levofloxacin 500 mg daily for neutropenic prophylaxis.She underwent an unrelated matched allogeneic stem cell transplant and received GHVD prophylaxis with cyclophosphamide, tacrolimus, and mycophenolate.Three days prior to the transplant, she had a fall with head strike, with subsequent pain and swelling around right eye and CT scan of head showing a right frontal and periorbital scalp hematoma.