Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review

Abstract

Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species ( Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.

“Chronic granulomatous invasive fungal rhinosinusitis associated with SARS-CoV-2 infection: A case report”

“…Even though proptosis, enlarging mass on facial region, and nasal obstruction are main findings in advanced stages in most cases [ 16 ], our patient referred only orbital symptoms and no proptosis was seen throughout her follow-up. Severe complications of GCIFR include intracranial involvement, blindness, orbital extension, and death [ 3 ].…”

“…Patients with stage 3 disease with extensive disease IV followed by oral antifungal therapy are adequate [ 17 ]. Topical antifungal therapy has been introduced as an adjuvant therapy in patients with GCIFR with excellent outcomes [ 16 ]. Additionally, underlying comorbidities should be addressed and controlled with multidisciplinary consultations.…”

Invasive fungal infection caused by curvularia species in a patient with intranasal drug use: A case report

“…CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult [ 5 , 10 , 11 ]. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well [ [7] , [8] , [9] , 11 ]. Usually, Curvularia species is associated with less severe diagnoses, including allergic rhinosinusitis, onychomycosis, and dermatitis [ 7 ].…”

“…These infections are most frequently caused by Aspergillus species. Few cases in the literature have reported the cause due to Curvularia species [ [7] , [8] , [9] ]. In this case report, we describe an immunocompetent patient with intranasal cocaine and perfume inhalant use who developed invasive fungal sinusitis due to Curvularia species with disseminated disease.…”

Allergic Fungal Rhinosinusitis in Saudi Arabia: A Review of Recent Literature

“…Al Mulhem et al [ 56 ] have reported one case of granuloma in a sample of 15 patients with AFRS. Alarifi et al [ 57 ] have reported a case of AFRS in a patient who previously had chronic granulomatous invasive fungal sinusitis. Although it may be a different pathology, a transformation of previous illness cannot be excluded.…”