Abstract
Acute invasive fungal rhinosinusitis (AIFRS) can spread beyond the sinonasal cavity. It is necessary to analyze the association between the specific site involved in the extrasinonasal area and the survival rate to predict patient prognosis. We investigated 50 patients who had extrasinonasal lesions on preoperative gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) scan and underwent wide surgical resection of AIFRS. The specific sites with loss of contrast enhancement (LoCE) on Gd-enhanced MRI were analyzed for AIFRS-specific survival rate. The most common underlying disease was diabetes mellitus followed by hematological malignancy. The most common symptoms were headache and facial pain. Seven patients (14.0%) expired because of AIFRS progression. Poor prognosis was independently associated with LoCE at the skull base on preoperative MRI (HR = 35.846, P = 0.004). In patients with AIFRS extending to the extrasinonasal area, LoCE at the skull base was an independent poor prognostic factor.
Highlights
Acute invasive fungal rhinosinusitis (AIFRS) can spread beyond the sinonasal cavity
When AIFRS extends beyond the sinonasal cavity, the surgeon has to predict the prognosis and determine the extent of surgical removal
The involvement of the skull base, in the body and/or greater wing of the sphenoid bone and orbital apex, was identified as an independent poor prognostic factor in AIFRS extending to the extrasinonasal area
Summary
It is necessary to analyze the association between the specific site involved in the extrasinonasal area and the survival rate to predict patient prognosis. Acute invasive fungal rhinosinusitis (AIFRS) is a rare but fatal disease, in immune-compromised patients, including those with hematological malignancies, poorly controlled diabetes mellitus (DM), and those who received immunosuppressive treatment following organ transplantation or chemotherapy for solid organ malignancies[1,2,3]. Analyzing the relationship between the specific site of involvement in the extrasinonasal area and the survival rate is important in predicting patient prognosis. We aimed to analyze the clinical features of patients with AIFRS extending to the extrasinonasal area and to identify prognostic factors for AIFRS-specific survival rate in terms of specific sites involved
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