A schematic approach to preexisting sinus disease for the immunocompromised individual.
Fungal rhinosinusitis is an aggressive and potentially lethal complication of chemotherapy and bone marrow transplant-induced neutropenia. Preexisting noninvasive sinusitis may be a significant risk factor in this population. An illustrative case is presented where preexisting noninvasive fungal sinusitis developed into the tissue-invasive and angio-invasive form of aspergillosis during chemotherapy. We propose an algorithmic approach to all patients before chemotherapy or bone marrow transplantation. If there is a suspicion of sinusitis based on a screening questionnaire, we recommend an otolaryngology consultation and a CT of the paranasal sinuses. Evidence of sinus disease should then be treated aggressively before chemotherapy or a bone marrow transplantation. Close posttreatment surveillance during the neutropenic phase is necessary with "urgent" biopsies if recurrence of disease is suspected.
Mirza
N
N
Department of Otolaryngology, Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Montone
K T
KT
Stadtmauer
E A
EA
Lanza
D C
DC
D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host / Q000502:physiology*; D007951:Leukemia, Myeloid / Q000188:drug therapy; D008297:Male; D009181:Mycoses / Q000175:diagnosis; D012307:Risk Factors; D012852:Sinusitis / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy
D000970:Antineoplastic Agents