title: Chronic granulomatous invasive fungal sinusitis: an evolving approach to management.
abstract: BACKGROUND
  Chronic granulomatous invasive fungal sinusitis (CGIFS) is rare and a consensus on ideal management is lacking. We present an extensive case managed successfully with a conservative approach.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  The patient presented with unilateral proptosis, papilledema, and headache. Imaging revealed an infiltrative process with extensive intracranial and intraorbital involvement. Biopsy showed fungal elements and granulomatous reaction consistent with CGIFS. The patient was managed with conservative surgery and long-term oral voriconazole.
  
  
  CONCLUSIONS
  This case supports a conservative surgical approach in some patients with extensive CGIFS. Oral voriconazole is effective and has significant advantages over more toxic agents administered intravenously.
authors: Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Ashleigh
authors: A
authors: Halderman
authors: Rabin
authors: R
authors: Shrestha
authors: Raj
authors: R
authors: Sindwani
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D001232:Aspergillus fumigatus; D002908:Chronic Disease; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D011743:Pyrimidines / Q000627:therapeutic use; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole
keywords: Aspergillus fumigatus; fungus diseases; papilledema; sinusitis; voriconazole