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Mycoses Sep 2021Sinus fungal ball (SFB) is the most common type of non-invasive fungal sinusitis and develops mostly in immunocompetent individuals, whereas invasive fungal sinusitis...
BACKGROUND
Sinus fungal ball (SFB) is the most common type of non-invasive fungal sinusitis and develops mostly in immunocompetent individuals, whereas invasive fungal sinusitis (IFS), with high mortality, develops mostly in immunocompromised patients. SFB may progress to IFS depending on the patient's immune status and underlying diseases.
OBJECTIVES
To investigate the possibility of SFB progressing to IFS.
PATIENTS/METHODS
A total of 10 patients histopathologically diagnosed with concurrent IFS and SFB from January 2013 to December 2019 were enrolled. Their clinical characteristics, histopathology and clinical course information were obtained and compared with those of 56 patients with IFS alone and 617 patients with SFB alone.
RESULTS
Acute, chronic and chronic granulomatous IFS was diagnosed in two (20%), five (50%) and three (30%) patients, respectively. All patients had severe facial pain and/or headache, with the most common comorbidity being diabetes (n = 5, 50%). SFB was identified in the maxillary (60%) and sphenoid (40%) sinuses. The tissue culture was positive for Aspergillus species in five (50%) patients. Eight patients with chronic or chronic granulomatous IFS were successfully treated by debridement with voriconazole, and the two patients with acute IFS and severe neutropenia due to haematologic malignancy died. Compared to patients with IFS alone, patients with combined SFB and IFS were older, female dominant, and commonly had chronic or chronic granulomatous IFS. In addition, they were older and more commonly diabetic and immunocompromised than patients with SFB alone.
CONCLUSIONS
SFB may progress to IFS particularly in elderly and immunocompromised patients.
Topics: Aged; Aged, 80 and over; Aspergillus; Female; Humans; Invasive Fungal Infections; Male; Middle Aged; Paranasal Sinuses; Retrospective Studies; Sinusitis
PubMed: 34170564
DOI: 10.1111/myc.13343 -
Indian Journal of Otolaryngology and... Oct 2022Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be...
Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle.
PubMed: 36452689
DOI: 10.1007/s12070-020-02059-6 -
Cureus Feb 2023Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic disease that develops with necrotizing granulomatous inflammation and is characterized by...
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic disease that develops with necrotizing granulomatous inflammation and is characterized by eosinophilia, asthma, and small vessel vasculitis. We report the case of a 74-year-old woman with a history of asthma, admitted to the Emergency Room with fever, headache, general malaise, weight loss and night sweats with one-month evolution, previously medicated with antibiotics without improvement. She presented with sinus palpation tenderness and lower leg bilateral sensitivity impairment. Laboratory tests showed neutrophilia and eosinophilia, normocytic anemia and elevated erythrocyte sedimentation rate and C-reactive protein. A computed tomography revealed sphenoid and maxillary sinusitis. Blood cultures and lumbar puncture were innocent. An extended autoimmune panel exposed a strong positive perinuclear anti-neutrophil cytoplasmic antibody - myeloperoxidase (pANCA-MPO). Sinus biopsy showed tissue infiltration by eosinophils, confirming EGPA. Corticosteroid (1 mg/kg/day) treatment was started with gradual improvement. Six months later there were no signs of active disease under prednisolone 10 mg and azathioprine 50 mg/day. This case highlights that refractory sinusitis in the presence of constitutional syndrome and peripheral eosinophilia should alert clinicians to the possibility of EGPA, particularly in patients with late-onset asthma.
PubMed: 37007396
DOI: 10.7759/cureus.35512 -
Diagnostics (Basel, Switzerland) Apr 2024(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in...
(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.
PubMed: 38611671
DOI: 10.3390/diagnostics14070758 -
Vestnik Otorinolaringologii 2023Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or...
Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or incorrectly selected antimycotic therapy. Treatment of such patients must necessarily include the complete removal of fungal masses from the affected sinus and the further use of antimycotics that ensure complete elimination of the pathogen. A clinical case of chronic fungal operated isolated sphenoiditis caused by the fungus is presented. For extensive drainage of the sphenoid sinus, the patient underwent translamellar sphenoidotomy on the right with further antifungal therapy.
Topics: Humans; Schizophyllum; Sinusitis; Mycoses; Paranasal Sinuses
PubMed: 37184561
DOI: 10.17116/otorino20228802189 -
Malaysian Family Physician : the... Jul 2021Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled...
Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a "string of pearls" present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally. A middle-aged gentleman presented with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. A high index of suspicion is required for early diagnosis of fungal endophthalmitis.
PubMed: 34386173
DOI: 10.51866/cr1100 -
BMJ Case Reports Oct 2021We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and...
We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew , a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.
Topics: Brain Ischemia; Female; Humans; Ischemic Stroke; Middle Aged; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed
PubMed: 34607813
DOI: 10.1136/bcr-2021-242943 -
European Radiology Aug 2020To investigate MRI features in discriminating chronic invasive fungal rhinosinusitis (CIFRS) from sinonasal squamous cell carcinomas (SNSCC).
OBJECTIVES
To investigate MRI features in discriminating chronic invasive fungal rhinosinusitis (CIFRS) from sinonasal squamous cell carcinomas (SNSCC).
METHODS
MRI findings of 33 patients with CIFRS and 47 patients with SNSCC were retrospectively reviewed and compared. Multivariate logistic regression analysis was performed to identify significant imaging features in distinguishing between CIFRS and SNSCC. The ROC curves and the AUC were used to evaluate diagnostic performance.
RESULTS
There were significant differences in cavernous sinus involvement (p < 0.001), sphenoid sinus involvement (p < 0.001), meningeal involvement (p = 0.024), T2 signal intensity (p = 0.006), and enhancement pattern (p < 0.001) between CIFRS and SNSCC. Multivariate logistic regression analysis identified cavernous sinus involvement (odds ratio [OR] = 0.06, 95% confidence interval [95% CI] = 0.02-0.20) and sphenoid sinus involvement (OR = 0.14, 95% CI = 0.05-0.45) as significant indicators for CIFRS and T2 isointensity to gray matter (OR = 4.44, 95% CI = 1.22-16.22) was a significant indicator for SNSCC. ROC curve analysis showed the AUC from a combination of three imaging features was 0.95 in differentiating CIFRS and SNSCC.
CONCLUSIONS
MRI showed significant differences between CIFRS and SNSCC features. In immunocompromised patients, a sinonasal hypointense mass on T2WI with septal enhancement or loss of contrast enhancement, and involvement of cavernous sinus, sphenoid sinus, and meninges strongly suggest CIFRS.
KEY POINTS
• Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from sinonasal squamous cell carcinomas (SNSCC) in clinical practice. • Cavernous sinus and sphenoid sinus involvement appear to be significant indicators for CIFRS. T2 isointensity to gray matter appears to be a significant indicator for SNSCC. • Loss of contrast enhancement and septal enhancement can be used to distinguish CIFRS from SNSCC with a high degree of specificity.
Topics: Adult; Aged; Aspergillosis; Cavernous Sinus; Chronic Disease; Diagnosis, Differential; Epistaxis; Facial Pain; Female; Headache; Humans; Immunocompromised Host; Invasive Fungal Infections; Logistic Models; Magnetic Resonance Imaging; Male; Meninges; Middle Aged; Mucormycosis; Multivariate Analysis; Nasal Obstruction; Nose Neoplasms; Paranasal Sinus Neoplasms; Retrospective Studies; Rhinitis; Rhinorrhea; Sinusitis; Sphenoid Sinus; Squamous Cell Carcinoma of Head and Neck; Vision Disorders
PubMed: 32279114
DOI: 10.1007/s00330-020-06838-1 -
Radiation Oncology (London, England) Sep 2023To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the...
OBJECTIVE
To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients.
PATIENTS AND METHODS
A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS.
RESULTS
(1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040).
CONCLUSION
(1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.
Topics: Humans; Nasopharyngeal Carcinoma; Retrospective Studies; Sinusitis; Magnetic Resonance Imaging; Nasopharyngeal Neoplasms
PubMed: 37723540
DOI: 10.1186/s13014-023-02331-3 -
ORL; Journal For Oto-rhino-laryngology... 2020To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis.
OBJECTIVE
To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis.
MATERIALS AND METHODS
The records of patients diagnosed with isolated fungal sphenoiditis at Songklanagarind Hospital from January 2004 to December 2017 were retrospectively reviewed. Data related to demographics, clinical presentation, underlying disease, type of complication, surgical procedure, and clinical outcome were collected.
RESULTS
Among the 35 participating patients, complications were found at a rate of 40%. The most common complication was visual loss (71.43%). We also compared the clinical characteristics between patients with and without complications via univariate analysis. The enrolled patients consisted of 12 men and 23 women (1:2). The mean age was older in the complications group 64 (41-84) vs. 57.43 (36-81) years, respectively. Underlying diabetes mellitus and complete opacity of the sphenoid sinus were factors that related significantly to the occurrence of complications. After treatment, 35.72% of the participants made a complete recovery; underlying diabetes mellitus was associated with a poor prognosis.
CONCLUSION
This report indicates that practitioners must be careful of complications arising in elderly and female patients with isolated fungal sphenoiditis, who have a complete opacity of the sphenoid sinus and underlying diabetes mellitus.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Mycoses; Retrospective Studies; Sphenoid Sinus; Sphenoid Sinusitis; Tomography, X-Ray Computed
PubMed: 31743915
DOI: 10.1159/000503902