Invasive fungal rhinosinusitis in adult patients: Our experience in diagnosis and management

• Published in: Journal of cranio-maxillo-facial surgery Vol. 44; no. 4; pp. 512 - 520
• Main Authors: Pagella, Fabio, De Bernardi, Francesca, Dalla Gasperina, Daniela, Pusateri, Alessandro, Matti, Elina, Avato, Irene, Cavanna, Caterina, Zappasodi, Patrizia, Bignami, Maurizio, Bernardini, Elena, Grossi, Paolo Antonio, Castelnuovo, Paolo
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.04.2016
• Subjects: Adult; Antifungal Agents - therapeutic use; Aspergillus; Dentistry; Endoscopic sinus surgery; Fungal rhinosinusitis; Humans; Mucor; Mycoses - diagnosis; Mycoses - drug therapy; Mycosis; Paranasal Sinuses; Rhinitis - diagnosis; Rhinitis - drug therapy; Rhinitis - microbiology; Sinusitis - diagnosis; Sinusitis - drug therapy; Sinusitis - microbiology; Skull base; Surgery; Aspergillus; Mycosis; Skull base; Fungal rhinosinusitis; Endoscopic sinus surgery; Mucor
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2015.12.016

Abstract Background This paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults. Methods Medical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed. Results A total of 18 cases (10 acute and 8 chronic) were recorded. In acute form, haematological malignancies represented the principal comorbidity (100%), while in chronic form this was diabetes mellitus (87.5%). All patients received systemic antifungal agents. Endoscopic sinus surgery was performed in 16/18 patients (88.9%). Among patients with an acute IFRS, 4/10 died of fungal infection (40%), on the other side 2/8 patients with chronic IFRS died of the evolution of the mycosis (25%). Conclusions Acute and chronic IFRS are different entities: in acute form, prognosis is poor, so therapy should be promptly performed, although host immune status and evolution of the haematological disease are key factors for the outcome. In chronic form, a wide surgical excision of the disease is recommended in order to obtain a complete removal of fungal infection. In both forms, early clinical findings are non-specific and ambiguous, so diagnosis depends on a high index of suspicion, taking into account predisposing factors.