[Invasive fungal rhinosinusitis in an apparently immunocompetant patient]

The incidence of invasive fungal rhinosinusitis is constantly increasing, due to the growing number of immunocompromised patients. We report the case of a 73-year-old patient with a severe aortic stenosis whose preoperative evaluation revealed a recurrence of a left maxillary sinusitis operated many years ago. The patient underwent meatotomy and drainage. Pathologic examination of the sinus mucosa revealed the presence of septate and branched fungal hyphae invading the blood vessels. The diagnosis of invasive aspergillosis was thus established and the patient was treated by oral voriconazole. Our report describes the case of an invasive chronic form of a fungal rhinosinusitis occurring in an immunocompromised patient, and exposes the different forms of invasive fungal rhinosinusitis. The diagnosis of an invasive form of fungal rhinusinusitis should be suspected in immunocompromised patients in particular, but also in immunocompetent patients. The appropriate treatment should be promptly set up, given the bad prognosis of acute and fulminant cases.