Clinical Management of Invasive Fungal Sinisitis

Objective Invasive fungal sinusitis (IFS) has increased in recent years with the use of steroids and onset of diabetes mellitus. The most frequently observed fungal sinusitis infections are typically associated with Aspergillus . Although most cases of fungal sinusitis are noninvasive, the infection occasionally develops into an invasive type, particularly in immunocompromised patients. Method Because of its progressive nature, IFS is a potentially fatal disease with a relatively high overall mortality rate. Once manifested, the fungus frequently involves the orbit of the eye and intracranial area. Although optimum treatment methodologies are still controversial, early diagnosis and treatment of the disease is generally accepted as essential to achieving a positive patient outcome. Several recent reports have claimed successful management of IFS by systemic administration of new anti‐fungal agents such as voriconazole, or combination therapy using debridement and anti‐fungal agents. Results Here, we report on the clinical features and outcomes of 4 patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of anti fungal agents and surgical intervention is discussed. Strategic treatment employing both surgery and systemic administration of antifungal agents was performed in all patients. One patient with invasion into the cavernous sinus died of brain infarction. The remaining three patients are still alive. Conclusion Observations of patients in the present case study suggest that early diagnosis and strategic treatment may contribute to improvement in the prognosis of IFS.