Clinical Study of Invasive Fungal Rhinosinusitis of the Sphenoid Sinus with an Orbital Tip Lesion

Abstract

　Rarely, fungal rhinosinusitis is of the invasive type, with a poor prognosis. The invasive type can cause cranial nerve symptoms depending on the site of fungal infiltration. In this study, we investigated clinical features, diagnosis, treatment, and prognostic markers for infection control in four cases of invasive fungal rhinosinusitis.

　The patients were two men and two women in the age range of 70-84 years. Three of the four patients were suspected as having invasive fungal rhinosinusitis based on the typical findings on CT/MRI, i.e., bone destruction on CT and low to no signal intensity on T2-weighted MRI; however, in the remaining one patient without a fungal mass, the diagnosis could not be suspected either by preoperative imaging examinations or during surgery. Postoperative histology revealed Aspergillus infection in all cases. All the four patients are alive, although only poor infection control was achieved in one patient with clival bone involvement.