Aggressive invasive fungal sinusitis.

Invasive sinonasal fungal disease is a potentially fatal process when it involves intracranial extension. Even though this invasive disease is relatively rare, its incidence is now higher than it once was because of the increased number of immunosuppressed patients. [1,2] However, in the case presented here, that of a black 13-year-old girl, the patient had no clinical evidence of immunosuppression.

Computed tomography (CT) revealed that she had an extensive invasive allergic fungal rhinosinusitis (figure 1). A biopsy revealed aspergillosis. On magnetic resonance imaging (MRI), extensive intraorbital involvement and early intracranial extension were demonstrated (figure 2). This finding prompted aggressive management with surgical debridement and systemic antifungal therapy.

From the Department of Radiology, Louisiana State University Health Science Center, New Orleans (Dr. Palacios and Dr. D'Antonio), and the Department of Radiology and Otolaryngology, University of Illinois Medical Center, Chicago (Dr. Valvassori).

References

(1.) Houser SM, Corey JP. Allergic fungal rhinosinusitis: Pathophysiology, epidemiology, and diagnosis. Otolaryngol Clin North Am 2000;33:399-409.

(2.) Rizk SS, Kraus DH, Gerresheim G, Mudan S. Aggressive combination treatment for invasive fungal sinusitis in immunocompromised patients. Ear Nose Throat J 2000;79:278-80, 282, 284-5.