Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review.

Naif H Alotaibi,Eyas Othman,Haifa Alsheikh,Zeyad Mahasin,Fawziah Al Mana,Omar Abu Omar,Mays Altahan

doi:10.3389/fsurg.2020.608342

Abstract

Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management.Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded.Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death.Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.

Highlights

Chronic Invasive Fungal Sinusitis (CIFS) is a sub-entity of fungal rhinosinusitis, with histopathological evidence of fungal invasion to the soft tissue of nasal and paranasal sinuses
We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management
CIFS classically presents in known healthy individuals, unlike Acute Invasive Fungal Sinusitis (AIFS), which usually arises in immunocompromised hosts

Summary

Introduction

Chronic Invasive Fungal Sinusitis (CIFS) is a sub-entity of fungal rhinosinusitis, with histopathological evidence of fungal invasion to the soft tissue of nasal and paranasal sinuses. Invasive fungal sinusitis (IFS) mostly affects immunocompromised patients, including patients with diabetes or solid organ transplant recipients, which has a rapid, aggressive course. CIFS classically presents in known healthy individuals, unlike Acute Invasive Fungal Sinusitis (AIFS), which usually arises in immunocompromised hosts. The absence of apparent predisposing factors can lead to a diagnostic dilemma and delay in surgical or medical interventions. Facial pain, rhinorrhea, headaches, and epistaxis are non-specific symptoms that are repeatedly seen in patients with CIFS. If neglected and kept untreated, CIFS can lead to invasion to neighboring structures and possible medical manifestations, including proptosis, altered mental status, seizures, and intracranial complications (1, 2)

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