title: Invasive sphenoidal aspergillosis: successful treatment with sphenoidotomy and voriconazole.
abstract: Treatment of invasive sphenoidal aspergillosis is surgical, followed by antifungal therapy, mostly amphotericin B. To optimize the adjuvant antifungal treatment, which is often limited by severe side effects, the new triazole antifungal agent voriconazole with broad coverage of fungal pathogens including Aspergillus was investigated in a study of 4 patients with clinical, radiological and histological signs of invasive sphenoidal aspergillosis. They first underwent endoscopic sphenoidotomy with drainage and extraction of the fungal mass. Postoperatively, 2 patients were immediately treated with voriconazole. Two patients initially received amphotericin B; but this treatment had to be stopped because of acute renal toxicity. Finally, all patients were treated orally with 200 mg voriconazole twice a day for 12-14 weeks. After this combined treatment all patients were asymptomatic and there were no endoscopic or radiological signs of residual fungal disease. The only side effects were nausea in one and transient visual disturbances in 2 other patients. In the 4 patients presented and treated, voriconazole was shown to be effective and less toxic than amphotericin B in adjuvant treatment of invasive sphenoidal aspergillosis.
authors.affiliation: Department of ENT, Head and Neck Surgery, University Hospital, Inselspital, Berne, Switzerland.
authors.forename: Ariane
authors.initials: A
authors.lastname: Baumann
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmerli
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hausler
authors.forename: Marco
authors.initials: M
authors.lastname: Caversaccio
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011743:Pyrimidines / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D015524:Sphenoid Sinusitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole