First report of chronic invasive fungal rhinosinusitis in a patient with ovarian cancer caused by Didymella pedeiae and successful treatment with voriconazole: A case report

Document Type : Case report


1 Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, PMB 3011, Kano, Nigeria

3 Department of Otorhinolaryngology, Faculty of Medicine, Tehran University of Medical Sciences, Amiralam Hospital, Tehran, Iran

4 Department of Medical Parasitology and Mycology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran



Background and Purpose: Didymella pedeiae is a dematiaceous fungus that belongs to the Coelomycetes class. While species within this class are known to cause human infection, D. pedeiae had previously only been known as phytopathogens and had never been isolated from a human sample.
Case report: A 51-year-old Iranian female patient with ovarian cancer was admitted with unilateral lesions in paranasal sinuses and a five-month history of nasal obstruction,headache, postnasal drainage, swelling on the left side of the face, and orbital pain.Paranasal sinus computerized tomography scan revealed a soft tissue mass that filled the left nasal cavity, ethmoid, sphenoid, and frontal sinuses with more involvement in the maxillary and ethmoid sinuses. Antifungal treatment was simultaneously initiated with itraconazole+prednisolone 15 mg/day, and levofloxacin. Due to poor clinical response,IV voriconazole and amphotericin B were added to the treatment as well. The patient recovered completely after 10 weeks of therapy.
Conclusion: Here, we report the first case of human D. pedeiae infection in a patient
with ovarian cancer.


 1. Montone KT, Livolsi VA, Feldman MD, Palmer J, Chiu AG,
Lanza DC, et al. Fungal rhinosinusitis: a retrospective
microbiologic and pathologic review of 400 patients at a single
university medical center. Int J Otolaryngol. 2012; 2012:684835.
2. Stringer SP, Ryan MW. Chronic invasive fungal rhinosinusitis.
Otolaryngol Clin North Am. 2000; 33(2):375-87.
3. Bakerspigel A. The isolation of
Phoma hibernica from a lesion
on a leg. Sabouraudia. 1969; 7(3):261-4.
4. Boroujeni ZB, Shamsaei S, Yarahmadi M, Getso MI, Khorashad
AS, Haghighi L, et al. Distribution of invasive fungal infections:
molecular epidemiology, etiology, clinical conditions, diagnosis
and risk factors: a 3-year experience with 490 patients under
intensive care. Microbial Pathog. 2020; 152:104616.
5. Clinical and Laboratory Standards Institute. Reference method
for broth dilution antifungal susceptibility testing of yeasts.
Wayne, PA: Clinical and Laboratory Standards Institute; 2008.
6. Baker JG, Salkin I, Forgacs P, Haines JH, Kemna ME. First
report of subcutaneous phaeohyphomycosis of the foot caused
Phoma minutella. J Clin Microbiol. 1987; 25(12):2395-
7. Hernández-Hernández F, Vargas-Arzola J, Ríos-Cruz OP,
Córdova-Martínez E, Manzano-Gayosso P, Segura-Salvador A.
First case of chromoblastomycosis due to
Phoma insulana.
Enferm Infecc Microbiol Clin. 2018; 36(2):95-9.
8. Miyakubo T, Todokoro D, Makimura K, Akiyama H. Fungal
keratitis caused by
Didymella gardeniae (formerly Phoma
) successfully treated with topical voriconazole and
miconazole. Med Mycol Case Rep. 2019; 24:90-2.
9. Rishi K, Font RL. Keratitis caused by an unusual fungus,
species. Cornea. 2003; 22(2):166-8.
10. Gordon M, Salkin I, Stone W.
Phoma (Peyronellaea) as
zoopathogen. Sabouraudia. 1975; 13(3):329-33.
11. Zaitz C, Heins-Vaccari EM, Freitas RS, Arriagada GL, Ruiz L,
Totoli SA, et al. Subcutaneous pheohyphomycosis caused by
Phoma cava. Report of a case and review of the literature. Rev
Inst Med Trop Sao Paulo. 1997; 39(1):43-8.
12. Rai M.
Phoma sorghina infection in human being.
Mycopathologia. 1989; 105(3):167-70.
13. Balis E, Velegraki A, Fragou A, Pefanis A, Kalabokas T,
Mountokalakis T. Lung mass caused by
Phoma exigua. Scand J
Infect Dis. 2006; 38(6-7):552-5.
14. Kukhar E, Smagulova A, Kiyan V. Biological properties
Phoma macrostoma related to non-dermatophyte  onychomycosis. Med Mycol Case Rep. 2020; 27:55-8.
15. Tullio V, Banche G, Allizond V, Roana J, Mandras N, Scalas D,
et al. Non-dermatophyte moulds as skin and nail foot mycosis
Phoma herbarum, Chaetomium globosum and
Microascus cinereus. Fungal Biol. 2010; 114(4):345-9.
16. Adamopoulou A, Sakellaris D, Koronis S, Balidis M,
Zachariadis Z, Tranos P, et al. Rare persistent corneal infection
Phoma sp. -a case report. Ophthalmol Ther. 2019; 8(1):143-8.
17. Salehi M, Zibafar E, Mahmoudi S, Hashemi S, Gatmiri S, Shoar
MG, et al. First report of invasive pulmonary infection by
Didymella microchlamydospora and successful treatment with
voriconazole. Clin Microbiol Infect. 2019; 25(3):392-3.
18. Roehm CE, Salazar JC, Hagstrom N, Valdez TA.
Phoma and
Acremonium invasive fungal rhinosinusitis in congenital acute
lymphocytic leukemia and literature review. Int J Pediatr
Otorhinolaryngol. 2012; 76(10):1387-91.