Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not?

Abstract

BackgroundChronic and granulomatous invasive fungal rhinosinusitis are important causes of blindness and craniocerebral complications. However, the classification of these 2 diseases remains controversial.MethodsWe retrospectively analyzed patients with chronic and granulomatous invasive fungal rhinosinusitus in a Chinese tertiary hospital from 2009 to 2017, with a focus on classification and comparisons.ResultsAmong 55 patients enrolled in our study, 11 (11/55, 20%) had granulomatous invasive fungal rhinosinusitis (GIFRS) and 44 (44/55, 80%) had chronic invasive fungal rhinosinusitis (CIFRS). Aspergillus fumigatus and Dematiaceous hyphomycetes were identified in 2 patients with GIFRS. Compared with granulomatous type, CIFRS was more frequently encountered in immunocompromised patients (P = .022), and the time from onset to diagnosis was much shorter (P = .001). Proptosis and orbital apex syndrome showed no significant difference between granulomatous and CIFRS in our study. The treatment options and prognosis of both diseases also showed no significant difference.ConclusionsDespite the consensus on histopathology, the classification of the chronic and granulomatous types may need further evaluation in clinical considerations.

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

“…GCIFR is an uncommon disease mainly caused by Aspergillus flavus infection with geographic predilection towards Sudan, India, Pakistan, and Saudi Arabia, with few cases reported in North America and none reported in Mexico ( Table 1 ) [ 3 , 8 ]. Its prevalence among individuals with clinical suspicion of fungal rhinosinusitis has been reported in approximately 20% in subtropical populations, unlike North America, with a prevalence of 0.5% [ 8 , 9 ].…”

“…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 ]. With orbital involvement, the orbital bone is eroded which may present as proptosis or orbital apex syndrome leading to temporal or permanent visual impairment [ 6 ].…”

“…Granulomatous chronic invasive fungal rhinosinusitis (GCIFR) is a rare entity with scarce cases reported mainly in subtropical areas of Sudan, India, Saudi Arabia, and Pakistan [ 2 ]. Few cases have been observed in the United States, with approximately two reported cases of GCIFR per year [ 3 ]. It is typically associated with Aspergillus flavus and the presence of noncaseating granulomas or Langerhans giant cells on histopathologic examination [ 4 ].…”

“…It is typically associated with Aspergillus flavus and the presence of noncaseating granulomas or Langerhans giant cells on histopathologic examination [ 4 ]. Clinically, patients present with a chronic rhinosinusitis syndrome associated with proptosis, headache, and an enlarging mass affecting the orbit, nose and paranasal sinuses [ [2] , [3] , [4] , [5] ]. However, atypical clinical manifestations should be considered.…”

The Development of Glaucoma after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study

“…In addition to the respiratory-related mechanism, the presence of CRS may result in the involvement of adjacent tissue, such as orbital bone preseptal soft tissues and the ocular adnexa [32]. In its severe form, orbital apex syndrome and cavernous sinus thrombosis may even occur, which require prompt and proper management to restore visual acuity [32,33,34]. These disorders could contribute compressive force to the globe and the impairment of ocular venous drainage, which can lead to ocular hypertension or glaucoma [35].…”