Successful Treatment of Invasive Rhinopulmonary Mucormycosis With an Indolent Presentation by Combined Medical and Surgical Therapy

Kim, Seung Tae; Kim, Woo Sung; Lee, Hwan Ho; Kim, Joo Yeon

doi:10.1097/scs.0b013e318280196b

Cited by 9 publications

(12 citation statements)

References 10 publications

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“…We agree with Tyson et al, 5 Seung et al 7 Jung H, et al 11 and Ketenci et al 27 that an only surgical treatment in immunocompetent patients is possible. Interestingly, there has been a rise in the reported cases of acute and chronic mucormycosis.…”

Section: Discussionsupporting

confidence: 91%

“…5 10 26 Other authors have corroborated single paranasal sinus disease on immunocompetent patients. 7 11 12 15 16 See Table 2 and 3 for a brief review of the literature.…”

Section: Discussionmentioning

confidence: 99%

“…15 Therefore, there is controversy on the best treatment available for this pathology. Some authors advocate a surgical and amphotericin B treatment, 4 7 27 28 while others support only the surgical or medical treatment, such as monotherapy. 11 12 These patients, as many authors point out, have different comorbidities that contraindicate either the use of amphotericin or surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…5 Patients are usually immunosuppressed individuals, and the clinical hallmark has been vascular invasion with tissue necrosis. 6 Nonetheless, new cases of indolent mucormycosis are being reported, occurring among immunosuppressed 4 7 8 9 and immunocompetent patients. 10 11 12 13 14 15 The clinical characteristics are distinguished by its chronic evolution, 14 nonspecific symptoms and in some cases absence of frank vascular invasion and necrosis.…”

Section: Introductionmentioning

confidence: 99%

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An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

Celis‐Aguilar

Burgos-Páez

Villanueva-Ramos

et al. 2018

Int Arch Otorhinolaryngol

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Introduction Indolent or chronic mucormycosis is a rare entity that affects both immunosuppressed and immunocompetent individuals. Additionally, its clinical evolution is nonspecific and there is no standardized treatment for this condition. Objective To describe the clinical characteristics and management of patients with indolent mucormycosis. Methods In the project of study with chart review in the Interinstitutional secondary care centers, patients with evidence of indolent mucormycosis, defined as pathological confirmation of nasal/paranasal sinus mucormycosis for more than 1 month, were included. All patients underwent complete laboratory workup, imaging studies, surgical treatment and adequate follow-up. No evidence of disease status was defined when patient had subsequent biopsies with no evidence of mucormycosis. Results We included seven patients, three female and four male subjects. The mean age was 53.14 years. Four patients were immunosuppressed and three immunocompetent. Among the immunosuppressed patients three had diabetes and one had dermatomyositis. The symptoms were nonspecific: facial pain/headache, mucoid discharge and cacosmia were the ones most frequently reported. Maxillary sinus involvement was present in all patients. Two immunosuppressed subjects received amphotericin. Posaconazole was the only treatment in one immunosuppressed patient. All immunocompetent patients had single paranasal sinus disease and received only surgical treatment. All patients are alive and free of disease. Conclusion Indolent mucormycosis is a new and emerging clinical entity in immunosuppressed and immunocompetent patients. Single paranasal sinus disease is a frequent presentation and should not be overlooked as a differential diagnosis in these patients. Immunocompetent patients should only be treated surgically.

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Section: Discussionsupporting

confidence: 91%

“…5 10 26 Other authors have corroborated single paranasal sinus disease on immunocompetent patients. 7 11 12 15 16 See Table 2 and 3 for a brief review of the literature.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

Celis‐Aguilar

Burgos-Páez

Villanueva-Ramos

et al. 2018

Int Arch Otorhinolaryngol

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“…12 Topical amphotericin B therapy has been used in several patients with invasive fungal infections of the nasal and respiratory tracts. 13,14 Amphotericin B has documented in vitro antifungal activity; as such, topical use seems possible and effective. 15 Amphotericin irrigations have been used with good success, both in isolation and in conjunction with intravenous antifungal therapy for invasive fungal rhinosinusitis and may assist a greater response and organ preservation.…”

Section: Discussionmentioning

confidence: 99%

Fungal Septal Abscess Complicating Maxillary Sinus Fungus Balls in an Immunocompetent Host

Patel

Orlandi

2015

Allergy�Rhinol (Providence)

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Background:Fungal infections of the nasal cavity can be destructive entities that are typically seen in immunocompromised hosts. We present a case of a localized fungal abscess of the nasal septum in an immunocompetent host after endoscopic treatment of maxillary sinus fungus balls.Method:A 51-year-old woman with a history of asthma and recent treatment with oral steroids presented with bilateral maxillary sinus mycetomas. She underwent endoscopic sinus surgery. The postoperative course was complicated by an asthma flare, which required oral steroids. The patient returned with nasal obstruction, and results of a physical examination were consistent with a nasal septal abscess. Drainage was attempted, and cultures showed fungal elements. The abscess reaccumulated, and the patient was referred to our institution. Operative drainage was performed with placement of a catheter in the septal abscess cavity. Forty-eight hours of amphotericin irrigations were performed through this site. The patient was started on oral antifungal therapy. Results of an immune workup, including testing for human immunodeficiency virus and assessing immunoglobulin levels, were negative. Final fungal cultures grew Scedosporium apiospermum sensitive to voriconazole. The patient completed therapy without further recurrence. Follow-up at 6 months demonstrated no further recurrence of her fungal septal infection.Conclusion:Sinonasal fungal infections rarely occur in immunocompetent hosts. The septum may have been seeded during the endoscopic sinus surgery. The use of oral steroids may have been a risk factor for the development of an aggressive nasal septal fungal abscess in this patient. This is the first reported case of a nasal septal abscess in an otherwise immunocompetent host with S. apiospermum.

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Oral/Dental Oncology

Watters¹,

Hansen²

2018

Oral, Head and Neck Oncology and Reconstructive Surgery

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Successful Treatment of Invasive Rhinopulmonary Mucormycosis With an Indolent Presentation by Combined Medical and Surgical Therapy

Cited by 9 publications

References 10 publications

An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

Fungal Septal Abscess Complicating Maxillary Sinus Fungus Balls in an Immunocompetent Host

Oral/Dental Oncology

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