Intranasal fungal (Alternaria) infection related to nasal steroid spray

During the past three decades intranasal corticosteroid sprays have been proven to be efficient and reasonably safe for the treatment of rhinitis, sinusitis and nasal polyposis. The adverse effects are generally localized and self-limited and rarely systemic or significant. We report an immunocompetent female treated with triamcinolone acetonide nasal spray for chronic rhinitis in whom an intranasal fungal infection with Alternaria species developed three months later. The infection was refractory to topical therapies alone, and was resolved with a combination of systemic and topical antifungal therapy. We also described the clinical manifestations of this rare infection and our therapeutic experience. In addition, we reviewed previous literature of fungal infections related to nasal corticosteroid sprays and compared them with our report.