Invasive fungal rhinosinusitis, clinical manifestations, and prognostic values: as case series audit

Abstract

BackgroundInvasive fungal rhinosinusitis (IFRS) is a rare disorder with a high mortality rate. In this study, we reported four rare cases, two of them being the first reports in the literature, in addition, we reviewed retrospectively and discussed the effects of causative fungi, comorbid disorders, and intracranial involvement on mortality rate in 20 IFRS patients treated in the otolaryngology clinic between May 2019 and May 2021.ResultsThere were 10 (50%) males and 10 females with a median age of 51 years. Seven patients had rhinomaxillary, 11 had rhino-orbito-cerebral IFRS, and two had atypical presentations that could not be classified. The most frequent comorbid condition was diabetes mellitus (DM), and the most frequent causative fungi were Mucormycetes. There was no difference between DM and other comorbidity groups for orbital involvement (p = 0.37), intracranial involvement (p = 0.17), hard palate involvement (p = 1), cranial nerve palsies (p = 0.17), causative fungi (p = 0.14), or mortality (p = 0.35). Mucormycetes and other fungi were similar for orbital involvement (p = 0.34), intracranial involvement (p = 0.16), hard palate involvement (p = 0.64), and mortality rate (p=0.35); however, cranial nerve palsies were significantly more frequent in Mucormycetes group (p = 0.04).ConclusionsUrgent diagnosis and multidisciplinary treatment are mandatory in IFRS. Due to its high mortality rate, IFRS should always be kept in mind in cases with atypical presentation, particularly if the patient is in the risk group. The current gold standard in IFRS management is urgent wide surgical debridement and concomitant administration of antifungals.