Acute invasive fungal rhinosinusitis: our experience with 18 cases.
Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive life threatening infection that is seen most commonly among immunocompromised patients. We present a case series of 18 patients clinically and histopathologically diagnosed with AIFRS with a mean follow-up of 9.11 ± 2.51 months (range 6-17). Demographic data, apparent symptoms and signs, underlying disorders, and outcomes are discussed. The mean age was 39.56 ± 20.66 years (range 2-75). The most common underlying diseases were diabetes mellitus (50 %) and leukemia (44.44 %). Mucosal biopsy confirmed fungal invasion of the nasal mucosa in all cases. The main fungi were Rhizopus oryzae (55.56 %), Absidia mucor (16.67 %), and Aspergillus fumigatus (27.78 %). Headache and facial pain (77.8 %), facial paresthesia (55.6 %), and ophthalmoplegia (33.3 %) were the most common symptoms and signs. Computed tomography and endoscopic findings showed various stages of sinonasal (100 %), pterygopalatine fossa (55.56 %), orbital (44.45 %), and cerebral (5.56 %) involvement. All patients underwent serial surgical debridement (3.78 ± 1.80 times; range 2-8) simultaneously with systemic antifungal therapy and proper management of the underlying disease. The most extreme case with brain involvement survived and recovered with no evidence of recurrent disease following treatment. All patients were considered cured after two endoscopic negative histopathologic evaluations. Three patients (16.67 %) died, one from uncontrolled leukemia and two due to renal failure. AIFRS is a potentially fatal condition, however, early diagnosis and management of the underlying disease accompanied with systemic antifungal and aggressive serial surgical intervention appears to be effective in reducing mortality in most patients.
Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mehdi
M
Bakhshaee
Infectious Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Amin
A
Bojdi
Hematology-Oncology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abolghasem
A
Allahyari
Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad Reza
MR
Majidi
Mashhad University of Medical Sciences, Mashhad, Iran.
Sherwin
S
Tavakol
Medical Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad Javad
MJ
Najafzadeh
Birjand University of Medicine, Birjand, Iran. masasghari58@bums.ac.ir.
Masoud
M
Asghari
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D002675:Child, Preschool; D002908:Chronic Disease; D003646:Debridement; D003920:Diabetes Mellitus; D004724:Endoscopy; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis*; D009297:Nasal Mucosa / Q000382:microbiology; D012220:Rhinitis / Q000150:complications / Q000382:microbiology*; D012852:Sinusitis / Q000150:complications / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D000935:Antifungal Agents
Diabetes mellitus; Immunocompromised; Invasive fungal rhinosinusitis; Leukemia