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Case Reports
. 2025 Sep 24;17(9):e93116.
doi: 10.7759/cureus.93116. eCollection 2025 Sep.

Necrotizing Pseudomonal Sinusitis in a Transplant Patient

Charlyn N Gomez  1 , Manaahil Rao  2 , Katya Prakash  3 , Andrea M Hebert  1 , Sunny J Haft  1
Affiliations
Case Reports

Necrotizing Pseudomonal Sinusitis in a Transplant Patient

Charlyn N Gomez et al. Cureus. .

Abstract

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 Pseudomonas 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.

Keywords: complicated sinusitis; invasive fungal sinusitis; necrotizing pseudomonal sinusitis; pseudomonas infections; transplant complication.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Pre-operative axial CT sinus
After presenting with bilateral facial swelling, right maxillary tenderness, and V2 numbness, the patient was found to have fat stranding, thickening, and enhancement of the retroantral (thick arrow) and premaxillary (dashed arrow) spaces on the right, indicative of pseudomonal spread outside of the sinonasal cavity.
Figure 2
Figure 2. Pre-operative axial CT of periorbital space
Preseptal enhancement within the periorbital space (white arrow) was also observed on imaging shortly after admission.
Figure 3
Figure 3. Post-operative day nine axial MRI sinus
Paranasal sinus necrosis (white arrow) and multiple phlegmons were seen on imaging, resulting in the patient returning to the OR for repeat debridement.
Figure 4
Figure 4. One-year post-operative MRI sinus
No findings indicating invasive disease in the sinuses, indicating resolution of infection.
See this image and copyright information in PMC

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