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

Publication date: Available online 9 January 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Fabio Pagella, Francesca De Bernardi, Daniela Dalla Gasperina, Alessandro Pusateri, Elina Matti, Irene Avato, Caterina Cavanna, Patrizia Zappasodi, Maurizio Bignami, Elena Bernardini, Paolo Antonio Grossi, Paolo Castelnuovo
BackgroundThis paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults.MethodsMedical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed.ResultsA 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 anti-fungal 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%).ConclusionsAcute 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.



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