Background: Aspergillus tubingensis is a black Aspergillus belonging to the Aspergillus section Nigri, which includes\r\nspecies that morphologically resemble Aspergillus niger. Recent developments in species determination have\r\nresulted in clinical isolates presumed to be Aspergillus niger being reclassified as Aspergillus tubingensis by\r\nsequencing. We present a report of a patient with an osteomyelitis of the maxillary bone with a probable invasive\r\nAspergillus tubingensis infection.\r\nCase presentation: We describe an immune compromised patient suffering from osteomyelitis of the maxillary\r\nbone after tooth extraction. The osteomyelitis probably resulted in dentogenic pansinusitis presenting as an acute\r\nethmoiditis. Histologic examination of biopsy samples showed osteomyelitis, and inflammation of the surrounding\r\nconnective tissue. Cultures of the alveolar wound grew Aspergillus tubingensis. The patient was treated with\r\nliposomal amphoterocin B, which was changed to oral treatment with voriconazole based on susceptibility testing\r\n(MIC for voriconazole was 1 �µg/ml).\r\nConclusion: This case shows that Aspergillus tubingensis may have the potential to cause severe invasive infections\r\nin immunocompromised hosts. A larger proportion of Aspergillus tubingensis isolates are less susceptible to azoles\r\ncompared to Aspergillus niger. Therefore, correct species identification and susceptibility testing is crucial for the\r\nchoice of anti-fungal treatment, screening of azole resistance, and characterization of the pathogenic potential of\r\nthe various species within Aspergillus section Nigri.
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