title: Highly effective unconventional management of aspergillosis of the left maxillary sinus in an 11-year-old girl with rhabdomyosarcoma embryonale of the frontal sinus.
abstract: Invasive fungal infections are common causes of death in children treated for malignancies, and therefore present an important and growing clinical problem. Fungal invasion usually affects immunocompromised patients, but increased incidences are also associated with intensification of antineoplastic therapy and increased numbers of organ and bone marrow transplantations. Fungal infections in parameningeal and cerebral locations carry high risks of treatment failure. We describe the case of an 11-year-old female patient with rhabdomyosarcoma embryonale of the frontal sinuses with metastases to the neck lymph nodes, treated according to the CWS 2002 protocol for high-risk patients. Left maxillary sinus aspergillosis was diagnosed during chemotherapy following radiotherapy, and 56 days after surgical excision of the tumour. No effect was achieved by use of amphotericin B. Further treatment included intravenous voriconazole at 6 mg per kg body weight every 12 h for 2 weeks, followed by oral voriconazole at 4 mg per kg body weight twice daily for 6 months. Simultaneous excision of necrotic tissues from the nasal cavity, ethmoid bone, maxillary sinus and frontal recess was performed. The sinus was kept open for 3 weeks to allow voriconazole lavage every 12 h for 3 weeks. This unconventional treatment resulted in eradication of sinus aspergillosis and allowed intensive chemotherapy to be continued with no recurrence of aspergillosis.
authors.affiliation: Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Peregud-Pogorzelski
authors.affiliation: Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Wawrykow
authors.affiliation: Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wozniak
authors.affiliation: Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Zakowska
authors.affiliation: Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Brodkiewicz
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D003646:Debridement; D004358:Drug Therapy / Q000379:methods; D005153:Facial Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy; D005260:Female; D005626:Frontal Sinus / Q000473:pathology*; D006801:Humans; D008443:Maxillary Sinus / Q000473:pathology*; D018233:Rhabdomyosarcoma, Embryonal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents