Cases Of Invasive Fungal Sinusitis Research Articles

Invasive Aspergillosis Mimicking Tolosa-Hunt Syndrome: A Case Report

Invasive fungal infection remains a major cause of morbidity and mortality in immunocompromised patients. Invasive fungal sinusitis can present as a Tolosa-Hunt syndrome (THS) or orbital apex, leading to frequent misdiagnosis. Accurate diagnosis of fungal infection invading the cavernous sinus or orbital apex is essential to reduce mortality through early antifungal treatment and reduce the risk of worsening with steroid treatment due to misdiagnosis of THS. Herein, we report a case of invasive fungal sinusitis mimicking THS.

A Curious Case of Invasive Fungal Sinusitis in a Post-COVID-19 Patient: A Case Report

Introduction: Secondary fungal infection following severe acute respiratory syndrome coronavirus 2 is a serious cause of concern as in majority of cases these are associated with devastating consequences. Invasive mucormycosis which was already prevalent in our country came back with a vengeance during the second wave of COVID-19. Methods: A 34-year-old male who had recovered from mild COVID disease developed invasive rhinosinusitis by two different fungi. The patient was followed up for clinical course, diagnosis, treatment, and outcome. Results: This case illustrates a first of a kind of an invasive fungal rhinosinusitis caused by two different fungi: Schizophyllum commune (of phylum Basidiomycota) and Rhizopus arrhizus (of the Mucorales group) in a patient who had recovered from COVID-19. In this case, conventional methods of direct detection and culture only revealed S. commune. Sequencing after DNA extraction from the paraffin blocks was done due to strong clinical suspicion of invasive mucormycosis and R. arrhizus was detected in the tissue sections. Appropriate antifungals for extended duration ensued complete eradication of the infection. Conclusion: Host risk factors are to be taken into consideration while diagnosing fungal infection. One needs to look beyond the obvious when clinical diagnosis is not consistent with the etiological agent isolated and in this regard molecular tools are a great help in establishing the etiological agent conclusively.

A Case of Invasive Fungal Sinusitis in the Onodi Cell with Recovery of Visual Acuity Despite Two Weeks Delay from Onset to Treatment

A Case of Invasive Fungal Sinusitis in the Onodi Cell with Recovery of Visual Acuity Despite Two Weeks Delay from Onset to Treatment

A case of invasive fungal sinusitis which caused trigeminal neuralgia attributed to mass lesion around the trigeminal nerve．

A case of invasive fungal sinusitis which caused trigeminal neuralgia attributed to mass lesion around the trigeminal nerve．

Invasive Fungal Sinusitis: Clinical Pathologic Characteristics of Acute vs. Chronic Infections

Abstract Introduction/Objective Invasive fungal sinusitis is a serious condition requiring early diagnosis and treatment. It has been classified into acute, chronic and granulomatous forms. This study aims to investigate clinical pathologic aspects such as a) Frequency of mass forming lesions, b) Frequency of granulomatous reaction, c) Frequency of acute inflammatory reaction and d) Frequency of angioinvasion, perineural invasion and necrosis, to determine if these factors allow a more meaningful clinical-pathologic classification. Methods/Case Report Cases of invasive fungal sinusitis with surgical pathology specimens available in our laboratory since January 1, 2006 to date were gathered. Electronic medical records, histopathologic diagnostic material and laboratory fungal identification results were reviewed. Results (if a Case Study enter NA) Thirty-one cases of invasive fungal sinusitis were found: Twenty-two were acute (< 4wk duration) and 9 chronic. Patient comorbidities in acute cases were malignancies: 45%, diabetes mellitus: 26% and solid organ transplant: 10%. Among patients with malignancies, 5 cases had relapsed/refractory acute myeloid leukemia with neutropenia < 1000/uL. Patients with diabetes mellitus exhibited an average HbA1c of 10.0%. Two out of 3 transplant patients had graft versus host disease. The most common causative fungi were species of Aspergillus, Candida and mucormycetes. By contrast, a third of the chronic cases had a history of recreational drug use and six presented with space occupying lesions seen on imaging studies. Upon histologic review, four of these showed granulomas and the majority of cases exhibited extensive necrosis. Among necrotic cases, perineural and vascular invasion by fungal organisms was identified. Conclusion We report the contrasting clinical pathologic characteristics of acute and chronic invasive fungal sinusitis in a series of cases treated at University affiliated tertiary/quaternary-care Hospitals. Acute invasive sinusitis is usually a complication of severe systemic diseases. Chronic cases are caused by various medical conditions including the use of recreational drug and may mimic neoplasms on imaging.

A rare case of invasive fungal sinusitis by co-infection of two fungi in a post COVID-19 patient: a case report

<p>Invasive fungal rhinosinusitis is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in acute fulminant form. Early symptoms can often mimic rhino sinusitis while late symptoms can cause significant morbidity and mortality. With early diagnosis and treatment can increase the patient survival. This case report is of 73 years old diabetic post COVID-19 patients. The patient presented to us was having severe headache and facial pain confined to left side cheek area with loosening of teeth. The patient underwent nasal cavity and biopsy from the maxillary sinus (left side) under local anaesthesia, which confirmed the diagnosis of invasive fungal sinusitis suggestive of co-infection by 2 fungi, aspergillus flavus and mucor. Further, the patient underwent surgical debridement and started on liposomal amphotericin B and patient improved significantly.</p>

A Case of Visual Loss Caused by Invasive Fungal Sinusitis of the Onodi Cell

Invasive fungal sinusitis is common in immunodeficiency patients and can spread into the orbit or intracranial cavity. The Onodi cell, which is one of the anatomical variations of the ethmoid sinus, refers to the space that has been pneumatized superolateral to the sphenoid sinus. We experienced a case of invasive fungal sinusitis that caused vision loss by invading the Onodi cells. Endoscopic sinus surgery and antifungal treatment successfully recovered the patient’s vision and we herein report on the case with a review of the literature.

A case of invasive fungal sinusitis by candida species causing blindness

Invasive fungal sinusitis (IFS) is a common manifestation in immunocompromised patients. The common offenders are Aspergillus and Mucor. These fungal infections can cause various systemic complications, both intracranial and extracranial. Ultimately it may lead to fungemia and death. Very few cases of IFS caused by candida have been reported in the literature. Candida is a yeast like fungus, present normally as a commensal in the oral cavity and skin. Invasive fungal sinusitis with central retinal artery occlusion (CRAO) with candida is extremely rare. We are reporting a case of cavernous sinus thrombosis (CST) with CRAO causing bilateral blindness in a patient with invasive candida sinusitis.

A case of invasive fungal sinusitis treated with orbital exenteration

A case of invasive fungal sinusitis treated with orbital exenteration

Not so pretty in pink: A clinical vignette on invasive fungal sinusitis

Invasive fungal infection is one of the most feared infectious complications in immunocompromised hosts following aggressive chemotherapy for hematologic malignancy and hematopoietic stem cell transplant (HSCT). The more common causes of sinusitis due to fungal pathogens (Mucorales, Fusarium, and Aspergillus spp) make up the majority of cases, but less common pathogens, including a number of dematiaceous fungi, can also be implicated. Early diagnosis is crucial; the mortality associated with fungal sinusitis is high and prompt, aggressive treatment is important for successful management. Prompt accurate microbiologic diagnosis is also crucial to direct effective treatment, especially in cases that do not respond to empiric therapy. Here we present an unusual case of invasive fungal sinusitis in a patient with relapsed refractory leukemia.

Managements and prognostic analyses in patients with invasive fungal rhinosinusitis

To evaluate the survival outcomes of invasive fungal rhinosinusitis by analyzing the clinical features. A retrospective analysis was performed for cases of invasive fungal sinusitis proved by histological analysis between March 2006 and November 2015. All relevant factors including interval from the onset of symptoms to initiation of diagnosis, clinical characteristics, features of CT and MRI, treatment and prognosis were collected. A total of 18 patients (10 males; 8 females) were identified. The median age was 54 years old. Three patients suffered from acute invasive fungal sinusitis, while the other 15 suffered from chronic invasive fungal sinusitis. The mean duration between onset of symptoms and diagnosis was 5 months. The most common symptom was headache (10/18), followed by visual disturbance (7/18), nasal obstruction (4/18), facial numbness and pain (2/18) and diplopia(2/18). Two patients had diabetes mellitus; one patient had ankylosing spondylitis receiving immunosuppressive drugs treatment for one year. Four patients had the disease confined in the sinus. Complications of this disease included orbital apex involvement in 6 patients, intraorbital and optic nerve involvement in 3 patients, cavernous sinus involvement in 5 patients, pterygopalatine fossa and infratemporal fossa involvement in 5 patients, intracranial extension involvement in 3 patients. Fungal species included aspergillus (15 cases) and mucor (3 cases). Seventeen patients received intravenous antifungal therapy after surgery. The duration of follow-up ranged from 1 to 60 months. Two patients reoccurred and one patient died of the disease. Endoscopic debridement combined with intravenous antifungals is efficacious in the management of invasive fungal sinusitis.

眼窩先端症候群を伴った浸潤型副鼻腔真菌症の2症例

浸潤型副鼻腔真菌症は予後不良で，頭蓋内進展した症例では致死率が高いことが知られている。われわれは当科で経験した眼窩先端症候群を伴う浸潤型副鼻腔真菌症2症例を報告する。症例1は80歳女性で，初療から診断までに時間を要し感染性脳動脈瘤破裂により死の転帰を辿った。症例2は84歳男性で，比較的早期の内視鏡下鼻内手術によりアスペルギルス感染を確定し，ボリコナゾール投与により救命することができた。眼窩先端部病変の診断は困難で，従来は開頭生検が行われていたため，高侵襲の生検が避けられてきた。現在は内視鏡下鼻内手術の発達により，低侵襲な生検が可能となっている。タイミングを得た生検による早期診断と副鼻腔内視鏡による生検法の更なる検討が今後の課題となる。

Invasive fungal sinusitis in a healthy athlete due to long‐term anabolic steroid use

Invasive fungal rhinosinusitis is a potentially fatal infection that affects immunocompromised patients. Prognosis is generally poor despite aggressive medical and surgical treatments. We present the first reported case of invasive fungal sinusitis in a healthy 18-year-old male athlete who was taking anabolic androgenic steroids (AAS). The effects of excessive AAS use on the immune system are not fully understood, but there may be consequences at supraphysiological concentrations. This case demonstrates potential immunomodulatory effects of anabolic steroids and highlights a previously unknown cause of invasive fungal sinusitis.

Cunninghamella echinulata causing fatally invasive fungal sinusitis

We report a fatal case of invasive fungal sinusitis caused by Cunninghamella echinulata in a febrile, neutropenic 15-year-old male with relapsing acute leukemia. The isolate was recovered from a nasal biopsy from the right middle meatus, and microscopic examination of the tissue revealed angioinvasion and necrosis. Human infection caused by this organism has not been well documented; however, this report alerts us to its life-threatening potential.

A Case of Relapse of Invasive Fungal Sinusitis after Endoscopic Sinus Surgery

Invasive fungal sinusitis is considered to have a poor prognosis. We report herein on a case of invasive fungal sinusitis successfully treated with endoscopic sinus surgery (ESS) but which relapsed 4 months after surgery. A 65-year-old man presenting with left cheek pain was found on computed tomography to have a heterogeneously enhanced mass in the anterior wall of the maxillary sinus and bone defects. We suspected a malignant tumor and performed diagnostic ESS. Fungus and necrotic mucosa were observed in the posterior wall of the maxillary sinus while necrotic mucosa and bone destruction were observed in the anterior wall. Endoscopic findings indicated a diagnosis of invasive fungal sinusitis and the patient underwent removal of the mucosa of the maxillary sinus with a modified endoscopic medial maxillectomy. Pathology confirmed invasive fungal sinusitis and Aspergillus fumigatus was detected on bacterial testing. The patient’s left cheek pain disappeared after surgery and micafungin was systemically administered for one month. However, follow-up CT at 4 months after surgery revealed recurrence in the orbit. Voriconazole was systemically administered and ESS was performed to confirm the diagnosis. Since we suspected that the fungus had invaded the lateral aspect of the maxillary bone, a total maxillectomy was performed, followed by systematic administration of voriconazole for 2 months. The patient was free from recurrence at the one-year follow up. This case suggests that, depending on the clinical course, aggressive surgery such as a total maxillectomy might be required for invasive fungal sinusitis.

Intranasal hydrocodone‐acetaminophen abuse induced necrosis of the nasal cavity and pharynx

Two million new users will abuse prescription narcotics this year, most commonly hydrocodone. The most commonly prescribed form is hydrocodone-acetaminophen (HA). Many individuals crush the tablets and snort the product to take advantage of the rapid transmucosal delivery of narcotics. The resultant pathology of intranasal hydrocodone acetaminophen abuse (INHAA) has been described only in a few case studies. Retrospective chart review. Two private and one academic otolaryngology practices in Kentucky searched their patient charts for patients with morbidity from intranasal abuse of hydrocodone acetaminophen tablets. We identified thirty-five patients who presented for treatment between 2004 and 2011. The majority of patients will initially deny the behavior, frequently delaying diagnosis. Physical exam findings of white powder covering an underlying nasal mucosal necrosis are characteristic of this condition during active INHAA. Follow up was limited as only 26% returned for follow-up care. Patients commonly presented with orofacial-nasal pain (43%) and sino-nasal congestion and discharge (43%). Active necrosis or prior tissue loss was noted in 77% of patients. Fifty-one percent of patients presented with septal perforations, and 26% with palatal perforations. Two cases of invasive fungal sinusitis were clearly documented, with one resulting in death. The vast majority of cases presented with characteristic physical findings that included acute necrosis of soft tissue, which can progress to destroy oronasal structures. In the absence of invasive fungal disease, the condition is self-limited after cessation of INHAA and performance of local nasal debridement and nasal hygiene.

Chronic fungal sinusitis leading to disastrous cerebral aspergillosis: a case report

Cerebral angioinvasion is a fatal complication of disseminated aspergillosis and has been rarely described in diabetic population in the absence of ketoacidosis. We present a case of invasive fungal sinusitis in a 79 year old diabetic man who presented with chronic frontal headaches. Despite appropriate medical and surgical treatment, the disease progressed and the patient eventually succumbed to a fatal ruptured mycotic aneurysm. We emphasize that clinicians should consider this in the differential diagnoses of all diabetics who present with chronic sinusitis, as early diagnosis could be the key in the successful treatment.

Resolution of invasive fungal sinusitis in immunocompromised patients: neutrophil count is crucial beside a combined medical and surgical approach

Dear Editor, Invasive fungal sinusitis is a rare, severe infection, typically occurring in immunocompromised patients who have impaired neutrophil function or who have received longterm immunosuppressive therapy [1]. Haematological patients and among them, those affected by acute leukaemia and myelodysplastic syndrome are at higher risk [2]. The occurrence of this complication often compromises the therapeutic programme for the underlying haematological condition, necessitating a delay or cessation of chemotherapy with a subsequent high risk of relapse or progression. The acute fulminant form is characterised by its speed of evolution and is associated with a high mortality rate that reaches 100% in cases of intracranial mycotic dissemination [3]. The clinical onset is generally subtle and insidious; facial swelling or pain with or without fever must be promptly considered as possible signs of invasive sinusitis. Computed tomography (CT) evidence of pronounced thickening of the mucosa of the nasal cavity strongly suggests the diagnosis, which can be confirmed by identification of the pathogenic fungus in sinus tissues. Surgical debridement of the affected sinus is a necessary diagnostic and therapeutic procedure and must be combined with systemic antifungal therapy. The fungi most frequently involved are Aspergillus and Zygomicetes. Prognosis is related to various factors, such as the speed of diagnosis and treatment, the type of fungal infection [3], dissemination to the central nervous system, and complete neutrophil recovery [4]. The scarce information in the literature on invasive fungal sinusitis in immunocompromised patients highlights the importance and efficacy of a combined surgical and medical approach [5]. However, the factors with a major role in the evolution of the infection have not been discussed. We describe here seven cases of invasive fungal sinusitis, observed at our institution between November 2006 and December 2008, in patients affected by acute leukaemia (five patients with acute myeloid leukaemia and two with acute lymphoblastic leukaemia). These seven cases occurred among a total of 130 patients with acute leukaemia newly diagnosed in the same period. Table 1 summarises the characteristics of these seven patients and their infections. In all cases, the infection developed while the patients were severely neutropenic (neutrophil count< 500/mmc); the neutropenia was chemotherapy-related in six patients, while in one case of acute leukaemic transformation of a myelodysplastic syndrome, it was an expression of the patient’s haematological disease. This last patient had never been treated before; two out of the other six patients had received only induction chemotherapy, while the other four patients had a prior history of more chemotherapy (1–8 lines of chemotherapy). Facial pain with or without facial swelling was the initial symptom in all cases, associated with fever in six out of the seven patients. CTscanning, which P. Zappasodi (*) :M. Rossi : C. Castagnola :A. Corso : M. Bonfichi :M. Lazzarino Division of Haematology, Foundation IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy e-mail: p.zappasodi@smatteo.pv.it

Fine‐needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine-needle aspiration biopsy (FNAB).Our patient was a 36-year-old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as "fibrous dysplasia." A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow-up, a culture/histopathologic examination could not be carried out.This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made.

A fatal case of invasive fungal sinusitis by Scopulariopsis acremonium in a bone marrow transplant recipient

A fatal case of Scopulariopsis acremonium sinus infection in an allogeneic hematopoietic stem cell transplant patient is reported. Rapid vascular diffusion of the fungus to the major head vessels was observed, which led to subsequent repeated cerebral ischemia and death. The presence of hyphae in the right carotid wall might be considered an indirect sign of fungal blood diffusion in the absence of positive blood cultures. The infection developed during the course of prolonged voriconazole prophylaxis, which was found to be effective in the in vitro antifungal drug assay. This finding induced us to consider the capacity of this drug to reach infected paranasal sinuses, and the need in cases such as this of a combined systemic and local pharmacological therapy or a combined medical and surgical approach.