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Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals
S Hussain1, N Salahuddin, I Ahmad
1Department of Radiology, Aga Khan University Medical Center, Karachi, Pakistan.
Abstract:
We report the computed tomographic appearance of invasive fungal disease of the paranasal sinuses in 13 patients. Coronal and axial computed tomographic images were obtained in each patient and data were analysed. Eight patients had Aspergillus flavus infection, four had Mucormycosis, and one had mixed Candida and Mucor. Our experience was different from that of other workers in many respects. All of our patients were immunocompetent. On radiological imaging by computed tomography, ethmoid sinuses were involved in 85% of our patients. In previously reported series maxillary sinuses were most frequently affected. Calcification in the inflammatory mass was not encountered in any of our patients, whereas this feature was present in many reported cases. Features in our patients that were similar to other studies were contrast enhancement, extension of the disease into the orbit and cranial cavity and a high mortality. The clinical course and radiological features of invasive mycosis simulate malignancy. Certain features that may help to differentiate invasive fungal infection from malignancy are discussed. We conclude that invasive fungal infection can affect immunocompetent individuals and should be considered in the differential diagnosis in appropriate clinical settings.
Insights
Invasive fungal infections of the paranasal sinuses can affect immunocompetent individuals, differing from typical presentations. Computed tomography reveals ethmoid sinus involvement is common, with high mortality despite unique imaging features.
Area of Science:
- Radiology
- Infectious Diseases
- Otolaryngology
Background:
- Invasive fungal infections (IFIs) of the paranasal sinuses are rare but serious conditions.
- Traditionally, IFIs are associated with immunocompromised patients.
- Computed tomography (CT) is crucial for diagnosing and assessing the extent of these infections.
Purpose of the Study:
- To describe the computed tomographic (CT) findings of invasive fungal disease in the paranasal sinuses.
- To highlight unique radiological features observed in a cohort of immunocompetent patients.
- To compare these findings with previously reported cases and discuss differential diagnoses.
Main Methods:
- Retrospective analysis of CT scans (coronal and axial) from 13 patients with invasive fungal sinusitis.
- Review of clinical data and outcomes.
- Comparison of imaging findings with existing literature.
Main Results:
- Eighty-five percent of patients had ethmoid sinus involvement, contrasting with previous reports favoring maxillary sinus disease.
- Calcification within the inflammatory mass was absent in this cohort, unlike in many reported cases.
- Common findings included contrast enhancement, orbital/cranial extension, and high mortality, similar to other studies.
Conclusions:
- Invasive fungal sinusitis can occur in immunocompetent individuals.
- CT imaging shows distinct patterns, with ethmoid sinus predilection in this series.
- Radiological features can mimic malignancy, necessitating careful differential diagnosis.