Invasive fungal sinusitis of isolated sphenoid sinus in immunocompetent subjects

Abstract

Invasive fungal sinusitis of the paranasal sinuses in a healthy immunocompetent person is uncommon. Isolated involvement of any paranasal sinus, particularly sphenoid sinus is rare. In this study, five immunocompetent patients who had no nasal complaints but obscure symptoms of headache and orbital symptoms such as diplopia, retro-orbital pain and loss of vision were diagnosed to be having fulminant fungal sinusitis of the sphenoid sinus. Three patients had aspergillosis and two patients had mucormycosis. These patients initially presented to neurologists and ophthalmologists because they had no ENT complaints. The diagnosis was made on endoscopy, radiology and histopathology. They were treated aggressively according to the standard protocols. The purpose of this paper is to bring to light the changing clinical spectrum of invasive fungal sinusitis. It can occur in immunocompetent patients and in the form of isolated sphenoid sinus involvement.

Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis

“…Frontal sinus involvement was less commonly seen (in two patients). Isolated sphenoid sinus involvement has also been reported in few studies [7]. None of our patients however, had isolated sphenoid sinus involvement.…”

Rhino-Orbital-Cerebral Mucormycosis With Different Cerebral Involvements: Infarct, Hemorrhage, and Ophthalmoplegia

“…A thickened sinus mucosa, cellulitis, cerebral ischemia, and inflammation will appear hypointense on T 1 -weighted MRI images and hyperintense on T 2 -weighted images (Dubey et al, 2005). Paranasal sinus masses or intracranial lesions may be hypointense on T 1 -and T 2 -weighted images, a feature that could be related to the increased accumulation of hemorrhagic products and paramagnetic materials such as iron, magnesium, and manganese (Dubey et al, 2005;Bhansali et al, 2004;Chopra et al, 2006;Dubey et al, 2005;Siegal et al, 2000).…”

“…Imaging of ROCM is based on the results of direct radiography, CT, and MRI. Radiographic findings of ROCM are not specific enough to distinguish mucormycosis from other sino-orbital conditions such as opacification or a fluid level in the paranasal sinuses with multiple sinus involvement (Hosseini & Borghei, 2005;Chopra et al, 2006;Ruoppi et al, 2001). Computed tomographic findings include mucosal thickening or enhancement of the soft tissue mass in the paranasal sinuses (Bennett et al, 1985).…”

Chronic invasive sinus and intracerebral aspergillosis controlled by combination therapy with micafungin and a daily dose of 400 mg itraconazole oral solution

“…This disease occurs mostly in patients with mild immunodeficiency, such as diabetes mellitus [1]. A combination of radical surgical resection of the infected tissue and physical treatment with antifungal therapy is very important to treat these cases [2,3]. When invasive surgery is unendurable, the prognosis is reportedly poor [4].…”