Acute invasive fungal rhinosinusitis: our experience in immunocompromised host

Acute invasive fungal rhinosinusitis (AIFRS) is a potentially fatal infection that usually affects immunocompromised patients. Early diagnosis and treatment, including aggressive surgical debridement, antifungal medication and correction of underlying predisposing factors are essential for recovery. The records of 13 patients histopathologically diagnosed with invasive fungal rhinosinusitis were retrospectively reviewed. Demographic data, presenting symptoms and signs, underlying diseases, and outcomes of the patients are presented. The most common underlying disease was diabetes mellitus. Mucoraceae (n-8) and aspergillus (n-5) were the main fungi found in AIFRS. Mucosal biopsy confirmed fungal invasion to the nasal mucosa in all cases. Computed tomography and endoscopic findings showed a predominance of unilateral disease, with various stages of nasal involvement. All patients underwent surgical debridement and systemic antifungal therapy immediately after diagnosis. Four patients died due to AIFRS. A poor prognosis was detected to the extensiveness of AIFRS and to the underlying disease (patients with diabetes and haematological diseases had the worst outcomes), but not to fungus isolated. Invasive fungal rhinosinusitis is discussed in light of the current literature.