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Background <p>Oral fungal infections are common in immunocompromised patients, particularly those treated for head and neck cancers. Radiation therapy disrupts mucosal integrity, predisposing patients to infections. While Candida species are the most frequent pathogens, rare fungi such as <i>Naganishia diffluens</i> and <i>Aspergillus ochraceus</i> can also cause infections, especially at previously irradiated sites.</p> Case Presentation <p>A 45-year-old male, treated with surgery and adjuvant radiotherapy for carcinoma of the left buccal mucosa in 2022, presented two years later with a painless nodulo-proliferative lesion on the left cheek accompanied by a discharging sinus. Imaging revealed osteoradionecrosis (ORN) of the mandible, and MALDI-TOF MS analysis of the discharge identified <i>Naganishia diffluens</i> and, subsequently, <i>Aspergillus ochraceus</i> on separate occasions. Both isolates were sensitive to voriconazole and amphotericin B. Oral voriconazole led to clinical improvement, with reduced discharge. A third fungal culture was sterile. In May 2025, the patient underwent full-thickness wide excision with left hemimandibulectomy; final histopathology showed no evidence of malignancy.</p> Conclusion <p>Post-radiation fungal infections can mimic tumor recurrence, particularly in endemic regions like India. Early identification and susceptibility-guided antifungal therapy are crucial to prevent misdiagnosis and unnecessary treatment.</p>

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Dual Deceivers: Naganishia Diffluens and Aspergillus Ochraceus Masquerading in Post-Radiation Mandibular Osteoradionecrosis

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Paras Kumar,
  • Madhumita Tripathi,
  • Sumith Lal,
  • Manoj Pandey

摘要

Background

Oral fungal infections are common in immunocompromised patients, particularly those treated for head and neck cancers. Radiation therapy disrupts mucosal integrity, predisposing patients to infections. While Candida species are the most frequent pathogens, rare fungi such as Naganishia diffluens and Aspergillus ochraceus can also cause infections, especially at previously irradiated sites.

Case Presentation

A 45-year-old male, treated with surgery and adjuvant radiotherapy for carcinoma of the left buccal mucosa in 2022, presented two years later with a painless nodulo-proliferative lesion on the left cheek accompanied by a discharging sinus. Imaging revealed osteoradionecrosis (ORN) of the mandible, and MALDI-TOF MS analysis of the discharge identified Naganishia diffluens and, subsequently, Aspergillus ochraceus on separate occasions. Both isolates were sensitive to voriconazole and amphotericin B. Oral voriconazole led to clinical improvement, with reduced discharge. A third fungal culture was sterile. In May 2025, the patient underwent full-thickness wide excision with left hemimandibulectomy; final histopathology showed no evidence of malignancy.

Conclusion

Post-radiation fungal infections can mimic tumor recurrence, particularly in endemic regions like India. Early identification and susceptibility-guided antifungal therapy are crucial to prevent misdiagnosis and unnecessary treatment.