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A schematic approach to preexisting sinus disease for the immunocompromised individual
N Mirza1, K T Montone, E A Stadtmauer
1Department of Otolaryngology, Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Abstract:
Fungal rhinosinusitis is an aggressive and potentially lethal complication of chemotherapy and bone marrow transplant-induced neutropenia. Preexisting noninvasive sinusitis may be a significant risk factor in this population. An illustrative case is presented where preexisting noninvasive fungal sinusitis developed into the tissue-invasive and angio-invasive form of aspergillosis during chemotherapy. We propose an algorithmic approach to all patients before chemotherapy or bone marrow transplantation. If there is a suspicion of sinusitis based on a screening questionnaire, we recommend an otolaryngology consultation and a CT of the paranasal sinuses. Evidence of sinus disease should then be treated aggressively before chemotherapy or a bone marrow transplantation. Close posttreatment surveillance during the neutropenic phase is necessary with "urgent" biopsies if recurrence of disease is suspected.
Insights
Fungal sinusitis can be a deadly complication for neutropenic patients undergoing chemotherapy or bone marrow transplants. Early detection and aggressive treatment of pre-existing sinus disease are crucial for patient survival.
Area of Science:
- Infectious Diseases
- Oncology
- Otolaryngology
Background:
- Fungal rhinosinusitis poses a severe threat to immunocompromised patients, particularly those with neutropenia from chemotherapy or bone marrow transplantation.
- Pre-existing noninvasive sinusitis is identified as a potential risk factor for developing invasive fungal infections in this vulnerable population.
Observation:
- A case study illustrates the progression of noninvasive fungal sinusitis to invasive aspergillosis during chemotherapy.
- This progression highlights the aggressive nature of fungal infections in neutropenic patients.
Findings:
- An algorithmic approach is proposed for managing sinusitis in patients before chemotherapy or bone marrow transplantation.
- Screening questionnaires, otolaryngology consultations, and CT scans are recommended for suspected sinusitis.
Implications:
- Aggressive treatment of diagnosed sinus disease prior to transplantation or chemotherapy is essential.
- Close post-treatment surveillance during neutropenia, including prompt biopsies for suspected recurrence, is critical for managing fungal infections.