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Invasive Fungal Rhinosinusitis: 41 cases

Authors: Matin Ghazizade, Mahboobe Asadi, Alimohammad Fakhr Yasseri and Reza Karimi

Int J Med Res Health Sci.78-81 | pdf PDF Full Text

Acute invasive fungal rhinosinusitis occurs almost exclusively in patients with immunodeficiency, particularly
cellular immunodeficiency. AIFRS rapidly spreads through nasal mucosa and sinus to the orbit and brain. Necrosis
and vascular invasion are characteristics of AIFRS. Diagnosis is made by biopsy and obvious fungal invasion
associated with necrosis in the nasal mucosa and underlying bone. High mortality rate has been reported in these
patients (50-80%). This case study reviewed patients treated for AIFRS in 2012 to 2014. Diagnosis was based on
clinical course of acute disease (less than 4 weeks) and fungal invasion confirmed by the pathology. Among 41
patients with AIFRS, fever was the most common initial manifestation (n = 33, 80.5%). Involvement of orbit (100%
vs. 18.2%, p<0.001,) skull base (100%, p=0.001) palate and nasal floor (83.3% vs. 15.2%, p=0002) and lateral
nasal wall (50.0% vs. 6.1%, p=0.019) was significantly higher in died patients than the improved patients. Recovery
was reported in 80% of patients receiving endoscopic and pharmaceutical treatment. Early treatment of patients
with sinus mucormycosis using endoscopic surgery improves overall survival. Poor prognosis was associated with
extranasal involvement such as orbit and central nervous system (CNS) involvement.

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