(1260) Rise of Curvularia-associated Chronic Granulomatous Invasive Fungal Sinusitis in the Southeast: Case Series and Review

Introduction: Chronic granulomatous invasive fungal sinusitis (CGIFS) is a rare form of indolent invasive fungal disease, typically with Aspergillus species in tropical or subtropical regions like southeast Asia.  Recently, reports of Curvularia-associated CGIFS have been noted in the southeastern United States (US).

Methods: A retrospective case series was performed of patients with biopsy-proven Curvularia-associated CGIFS at a tertiary academic center. Literature review was conducted using PubMed to identify cases of Curvularia-associated CGIFS from 1991 and 2025. Clinical presentation, imaging findings, pathology, treatment, and outcomes were reviewed.

Results: Two patients presented with months of progressive sinonasal and neurologic symptoms, including headache and trigeminal sensory changes. Imaging demonstrated polypoid mucosal disease with bony erosion and extension toward the orbit or skull base, initially mimicking inflammatory or neoplastic processes. Histopathology revealed granulomatous inflammation with fungal hyphae, and cultures grew Curvularia species in both cases. Both patients underwent functional endoscopic sinus surgery followed by systemic antifungal therapy and achieved clinical stability with medical management. Literature review identified 8 patients with Curvularia-associated CGIFS, with a notable prevalence in the southeastern US (7) and among African Americans.

Conclusions: Curvularia-associated CGIFS represents an uncommon but increasingly observed form of indolent invasive fungal sinusitis in the southeastern US. Tumor-like sinonasal disease with cranial neuropathies should prompt consideration of chronic invasive fungal infection as a differential with early biopsy, surgical intervention, and antifungal therapy critical for disease control.