Acute invasive fungal rhinosinusitis: A 15-year experience with 29 patients

Objectives: 1. To document our 15 year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFS). 2. To evaluate factors predictive of disease clearance and overall survival in this population Study Design: Case series with chart review Methods: Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy and treatment outcomes. Results: 29 patients with AIFS were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=10), medication (n=4) and AIDS (n=1). Facial pain and swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included mucorales (n=18) and aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFS was 59%. Intracranial (p=0.01) and ethmoid sinus (p=0.05) involvement were significantly linked with short-term diseaserelated mortality. Overall survival (OS) at 6 months was 21%. For overall survival, intracranial involvement (HR 4.47, 95% CI: 1.51 - 13.22) and cranial neuropathy at presentation (HR 3.2, 95% CI: 1.3 - 8.2) were significantly associated with shortened survival. Of the 5 patients surviving >6 months, 2 developed long-term major sinonasal complications. Conclusion: DSS and OS remain low for patients with AIFS. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of late sinonasal complications and should be followed closely.