Clinical profile and management of acute invasive fungal rhinosinusitis - our experience with 21 patients

Objective- Acute invasive fungal rhinosinusitis (AIFR) is a rapidly progressive disease, which usually develops in patients with uncontrolled diabetes mellitus (DM) and immunocompromised patients. The purpose of this study was to look retrospectively at the clinical profile, management and outcome of these patients. Study design- Retrospective chart review Settings- Tertiary care hospital Materials and methods- A retrospective chart review was done of patients diagnosed with AIFR between the years 2006 to 2011. RESULTS- Among the 21 patients, 17 (80.9) had uncontrolled diabetes mellitus. Nasal obstruction was the predominant symptom (16 patients, 76.2 percent). Mucosal changes were most commonly observed in the middle meatus (18 patients, 85.7 percent) and rhino-orbital disease was the most common presentation (11 patients, 52.4 percent). The most common causative fungal agent was Rhizopus (16 patients, 76.2 percent). Multiple surgeries were required in all except those patients who underwent endoscopic debridement with orbital exenteration. The mortality rate was 14.3 percent (3 patients). Conclusions- Early and aggressive surgical debridement, intravenous amphotericin B and prompt treatment of the underlying disease are the mainstay of AIFR treatment. Orbital involvement leads to higher mortality. Early orbital exenteration in patients, when indicated, has a better outcome because of reduced intracranial spread. Long term follow up and multiple surgical debridements when required, particularly in those who have not had orbital exenteration, are essential for a good outcome.