László Lujber1, Imre Gerlinger2, Adám Kuncz3, József Pytel4. 1. Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary, ; Tawam Hospital, Abu Dhabi, United Arab Emirates. 2. Department of Otolaryngology, Head and Neck Surgery, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom, and. 3. Tawam Hospital, Abu Dhabi, United Arab Emirates, ; Faculty of Medicine, Department of Neurosurgery, Szeged University, Szeged, Hungary. 4. Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary.
Abstract
BACKGROUND: Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy. OBJECTIVE: The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy. METHODS: Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient. RESULTS: After treatment, the patient experienced 3 years of disease-free follow-up. CONCLUSION: Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
BACKGROUND: Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy. OBJECTIVE: The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy. METHODS: Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient. RESULTS: After treatment, the patient experienced 3 years of disease-free follow-up. CONCLUSION: Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
Authors: A C Leenders; S Daenen; R L Jansen; W C Hop; B Lowenberg; P W Wijermans; J Cornelissen; R Herbrecht; H van der Lelie; H C Hoogsteden; H A Verbrugh; S de Marie Journal: Br J Haematol Date: 1998-10 Impact factor: 6.998