title: Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient.
abstract: BACKGROUND
  Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy.
  
  
  OBJECTIVE
  The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy.
  
  
  METHODS
  Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient.
  
  
  RESULTS
  After treatment, the patient experienced 3 years of disease-free follow-up.
  
  
  CONCLUSIONS
  Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
authors.affiliation: Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary, ; Tawam Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: László
authors.initials: L
authors.lastname: Lujber
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom, and.
authors.forename: Imre
authors.initials: I
authors.lastname: Gerlinger
authors.affiliation: Tawam Hospital, Abu Dhabi, United Arab Emirates, ; Faculty of Medicine, Department of Neurosurgery, Szeged University, Szeged, Hungary.
authors.forename: Adám
authors.initials: A
authors.lastname: Kuncz
authors.affiliation: Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Pytel
keywords: amphotericin B; aspergillosis; immunocompetent; invasive; rhinocerebral