Acute Invasive Fungal Rhinosinusitis: Insights on Mortality and Surgical Outcomes From a Cohort Study

Introduction Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive infection that primarily affects immunocompromised patients. This study aims to characterize the clinical and microbiological findings and assess treatment outcomes in cases with AIFRS. Material and methods A retrospective observational study was conducted between January 2013 and July 2024. Patients were included based on histopathological confirmation of fungal infection and clinical evidence of AIFRS. Data on demographics, comorbidities, symptoms, imaging, microbiology, treatment, and outcomes were collected. Results Thirteen patients were included, with a mean age of 49.7 (±15.9) years and a predominance of female sex (10/13). Diabetes mellitus and hematologic malignancies were the most common comorbidities (six and five cases, respectively). The most frequent pathogens were Aspergillus spp. and Mucorales spp. (six cases each). The sphenoid and ethmoid sinuses were the most commonly affected (11 cases each). Orbital invasion and cavernous sinus involvement were observed in 10 and five cases, respectively. Four patients underwent orbital exenteration and survived. Three patients, with distinct underlying etiologies and fungal pathogens, were treated concomitantly with hyperbaric oxygen therapy, with no reported fatalities. The overall mortality rate was 53.8%, with 38.5% directly attributed to AIFRS. Conclusion AIFRS, predominantly caused by Aspergillus spp. or Mucorales spp, is associated with high mortality, particularly in immunocompromised patients. Orbital involvement was frequent, and exenteration was performed in selected cases. Hyperbaric oxygen therapy was used as an adjunctive treatment in three patients, all of whom survived. These findings highlight the need for further studies to clarify therapeutic decision-making in AIFRS.