title: Neuro-ophthalmology of invasive fungal sinusitis: 14 consecutive patients and a review of the literature.
abstract: BACKGROUND
  Invasive fungal sinusitis is a rare condition that usually occurs in immunocompromised patients and often presents as an orbital apex syndrome. It is frequently misdiagnosed on presentation and is almost always lethal without early treatment.
  
  
  METHODS
  Retrospective case series of 14 consecutive patients with biopsy-proven invasive fungal sinusitis from four tertiary hospitals.
  
  
  METHODS
  Fourteen patients (10 men and 4 women; age range 46-82 years).
  
  
  METHODS
  Retrospective chart review of all patients presenting with invasive fungal sinusitis between 1994 and 2010 at each hospital, with a close analysis of the tempo of the disease to identify any potential window of opportunity for treatment.
  
  
  METHODS
  Demographic data, background medical history (including predisposing factors), symptoms, signs, radiological findings, histopathological findings, treatment approach and subsequent clinical course were recorded and analysed.
  
  
  RESULTS
  Only one patient was correctly diagnosed at presentation. Only two patients were not diabetic or immunocompromised. The tempo was acute in two patients, subacute in nine patients and chronic in three patients. In the subacute and chronic cases, there was about 1 week of opportunity for treatment, from the time there was a complete orbital apex syndrome, and still a chance for saving the patient, to the time there was central nervous system invasion, which was invariably fatal. Only two patients survived - both had orbital exenteration, as well as antifungal drug treatment.
  
  
  CONCLUSIONS
  Invasive fungal sinusitis can, rarely, occur in healthy individuals and should be suspected as a possible cause of a progressive orbital apex syndrome.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, USA. mj.thurtell@gmail.com
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thurtell
authors.forename: Alison L S
authors.initials: AL
authors.lastname: Chiu
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Goold
authors.forename: Gulden
authors.initials: G
authors.lastname: Akdal
authors.forename: John L
authors.initials: JL
authors.lastname: Crompton
authors.forename: Rebekah
authors.initials: R
authors.lastname: Ahmed
authors.forename: Simon N
authors.initials: SN
authors.lastname: Madge
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.forename: Ian
authors.initials: I
authors.lastname: Francis
authors.forename: Raf
authors.initials: R
authors.lastname: Ghabrial
authors.forename: Arj
authors.initials: A
authors.lastname: Ananda
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Raymond
authors.initials: R
authors.lastname: Chan
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: Thompson
authors.forename: Michael
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Peter J
authors.initials: PJ
authors.lastname: McCluskey
authors.forename: G Michael
authors.initials: GM
authors.lastname: Halmagyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002423:Cause of Death; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole
keywords: aspergillosis; cranial nerve palsy; invasive fungal sinusitis; mucormycosis; orbital apex syndrome.