Progressive external nasal destruction caused by presumed invasive sinonasal aspergillosis in an apparently immunocompetent infant: a case report

Abstract

Invasive sinonasal aspergillosis is a life-threatening infection classically seen in immunocompromised patients. It has occurred in infants with grade II protein-energy malnutrition without typical immunocompromising conditions. External cutaneous nasal extension further distinguishes this presentation from previously described paediatric cases. An 18-month-old girl with grade II protein-energy malnutrition presented with a 7-8-month history of progressive ulceration, crusting, and destruction of the external nose. Diagnostic nasal endoscopy under general anaesthesia revealed extensive black necrotic fungal debris within both nasal cavities. Histopathological examination of the biopsy specimen revealed slender septate fungal hyphae with acute-angle branching, consistent with Aspergillus species. There were no known immunocompromising conditions, although a full immunological workup was limited. The caregivers declined further evaluation and definitive treatment, and the child left against medical advice. This case demonstrates that presumed invasive sinonasal aspergillosis with external cutaneous extension can occur in infants even in the absence of known immunocompromising conditions. Early nasal endoscopy and prompt tissue biopsy are essential for timely diagnosis. Although grade II protein-energy malnutrition may have contributed to host susceptibility, its causal role cannot be established from a single case.