title: Proptosis as the initial presentation of fungal sinusitis in immunocompetent patients.
abstract: BACKGROUND
  Fungal sinusitis typically occurs in immunocompromised patients. The authors report four cases of fungal sinusitis in immunocompetent young adults, all of whom had proptosis.
  
  
  METHODS
  The diagnosis in all four patients was determined after orbital imaging and sinus biopsies.
  
  
  RESULTS
  All four patients required surgical removal of the fungal source and anti-fungal chemotherapy postoperatively.
  
  
  CONCLUSIONS
  Patients with proptosis, ocular pain, or other symptoms suggestive of orbital cellulitis unresponsive to antibiotic treatment should undergo radiographic imaging. If sinus disease is present, biopsy and culture may lead to the diagnosis of fungal disease. Surgical debridement and the appropriate systemic antifungal therapy usually lead to cure.
authors.affiliation: Ophthalmology Service, Fitzsimons Army Medical Center, Aurora, Colorado 80045-5001, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Heier
authors.forename: T A
authors.initials: TA
authors.lastname: Gardner
authors.forename: M J
authors.initials: MJ
authors.lastname: Hawes
authors.forename: K A
authors.initials: KA
authors.lastname: McGuire
authors.forename: W T
authors.initials: WT
authors.lastname: Walton
authors.forename: J
authors.initials: J
authors.lastname: Stock
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification; D005094:Exophthalmos / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D003904:Mitosporic Fungi / Q000302:isolation & purification; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D009297:Nasal Mucosa / Q000382:microbiology; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000187:drug effects / Q000382:microbiology / Q000601:surgery; D012852:Sinusitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity
chemical_list: D000935:Antifungal Agents