Acute fulminant fungal sinusitis: clinical presentation, radiological findings and treatment

Acute fulminant fungal sinusitis is characterized by acute symptoms and rap id progress with a mortality rate of 60-80%. A large number of survivors ha ve permanent neurological, visual and cosmetic disabilities. This clearly u nderscores the need of early recognition of this disease in at risk populat ion in order to start urgent treatment. The at-risk population of diabetics , AIDS and other immunosupressed is likely to increase, as will the inciden ce of acute fulminant fungal sinusitis. In the present study we have review ed nine cases of acute fulminant fungal sinusitis to determine clinical pre sentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Ma ny patients presented with blindness, facial paralysis and meningitis. Pred isposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patie nts were treated with of amphotrecin B or liposomal amphotericin B (AmBisom e), Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tis sues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or h istopathology in all cases. Surgical debridement was performed in seven cas es. Six out of nine patients survived but morbidity was high: only two pati ents survived without any permanent disability. (C) 2001 Elsevier Science B .V. All rights reserved.