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Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient
László Lujber1, Imre Gerlinger2, Adám Kuncz3
1Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary, ; Tawam Hospital, Abu Dhabi, United Arab Emirates.
Background:
Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy.
Objective:
The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy.
Methods:
Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient.
Results:
After treatment, the patient experienced 3 years of disease-free follow-up.
Conclusion:
Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
Insights
This study presents a successful treatment for invasive fungal rhinosinusitis in an immunocompetent patient. Combined surgical and antifungal therapy achieved a 3-year disease-free outcome, offering hope for similar chronic cases.
Area of Science:
- Infectious Diseases
- Mycology
- Otolaryngology
Background:
- Chronic invasive rhinocerebral aspergillosis therapy in immunocompetent patients remains controversial.
- High incidence reported in Sudan and Middle East.
- Diagnostic and therapeutic controversies stem from misinterpretation of criteria and pathophysiology.
Purpose of the Study:
- Detail clinical presentation and imaging findings of invasive Aspergillus rhinosinusitis with endocranial and orbital extension.
- Report on a treatment regimen combining surgical débridement, antifungal drugs, and immunomodulatory therapy.
Main Methods:
- Patient underwent endoscopic débridement.
- High-dose liposomal amphotericin B combined with flucytosine and immunomodulators administered.
- Surgical débridement and systemic antifungal therapy with immunomodulatory drugs utilized.
Main Results:
- The patient experienced a 3-year disease-free follow-up period post-treatment.
- Excellent long-term results achieved.
Conclusions:
- Combined surgical débridement and high-dose systemic antifungal therapy with immunomodulatory drugs are effective.
- This approach yielded excellent long-term results for extensive invasive fungal rhinosinusitis with cerebral and orbital involvement in an immunocompetent patient.
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