Clinical features and outcomes of four patients with invasive fungal sinusitis.
OBJECTIVE
The frequency of invasive fungal sinusitis (IFS) has increased in recent years with the use of steroids, onset of diabetes mellitus, and the administration of antibacterial agents. We report on the clinical features and outcomes of four patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of antifungal agents and surgical intervention is discussed.


METHODS
We treated four patients with IFS between March 2003 and November 2007 at Ehime University Hospital. Patients were two males and two females, aged from 61 to 74 years (mean 67.8 years).


RESULTS
With regard to clinical symptoms, headache was observed in all patients, and cranial nerve paralysis (visual disturbance, blindness, cheek paresthesia) was seen in 3 patients. β-D-Glucan levels in four patients were high compared with normal values. Aspergillus was histopathologically identified from biopsy specimens in all patients. One patient was complicated with Candida in addition to the Aspergillus infection. Orbital exenteration and ESS were performed in 2 patients as surgical debridement. In all patients, systemic administration of antifungal agents was initiated after surgery.


CONCLUSIONS
All patients received strategic treatment with surgery and systemic administration of anti-fungal agents. The single fatality was due to brain infarction caused by the spread of Aspergillus, and the remaining three patients are still alive. Our observations in these patients suggest that early diagnosis and strategic treatment may improve the prognosis of IFS.
Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Shitsukawa, To-on City, Ehime 791-0925, Japan. hitakaha@m.ehime-u.ac.jp
Hirotaka
H
Takahashi
Yasuyuki
Y
Hinohira
Naohito
N
Hato
Hiroyuki
H
Wakisaka
Jun
J
Hyodo
Toru
T
Ugumori
Kiyofumi
K
Gyo
D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D001706:Biopsy; D001766:Blindness / Q000209:etiology; D020520:Brain Infarction / Q000209:etiology; D002177:Candidiasis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002426:Cavernous Sinus / Q000473:pathology; D003131:Combined Modality Therapy; D003646:Debridement; D042241:Early Diagnosis; D054714:Echinocandins / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D055666:Lipopeptides / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D000077551:Micafungin; D008875:Middle Aged; D017233:Orbit Evisceration; D009916:Orbital Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology; D011743:Pyrimidines / Q000008:administration & dosage; D015524:Sphenoid Sinusitis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole; D000077551:Micafungin