A SCHEMATIC APPROACH TO PREEXISTING SINUS DISEASE FOR THE IMMUNOCOMPROMISED INDIVIDUAL

Fungal rhinosinusitis is all aggressive and potentially lethal complic ation of chemotherapy and bone marrow transplant-induced neutropenia. Preexisting noninvasive sinusitis may be a significant risk factor in this population. Al illustrative case is presented where preexisting n oninvasive fungal sinusitis developed into the tissue-invasive and ang io-invasive form of aspergillosis during chemotherapy. We propose an a lgorithmic approach to all patients before chemotherapy or bone marrow transplantation. If there is a suspicion of sinusitis based on a scre ening questionnaire, we recommend an otolaryngology consultation and a CT of the paranasal sinuses. Evidence of sinus disease should then be treated aggressively before chemotherapy or a bone marrow transplanta tion. Close posttreatment surveillance during the neutropenic phase is necessary with ''urgent'' biopsies if recurrence of disease is suspec ted.