Clinico-Pathological Study of Invasive Fungal Sinusitis in Ibadan, Nigeria: A Case Series

Abstract

Background: Invasive fungal sinusitis is one of the less common forms of fungal infection more commonly described in North Africa and Asia. It affects healthy and immunologically competent individuals typically complicating chronic rhinosinusitis. Surgical debridement and adjuvant antifungal treatment are the mainstay of management of this condition. Objective: To describe the clinical presentation, pathological features and management of patients with invasive fungal sinusitis managed at a tertiary health facility, southwestern Nigeria. Method: Medical records of all patients with invasive fungal sinusitis managed between January 2009 and December 2018 were retrospectively reviewed. Results: Six patients with invasive fungal sinusitis were managed during the study period. All patients were immunocompetent and the mean age at presentation was 30.7 years ± 7.2 years. The average duration of symptoms prior to presentation was 18.5 months (Interquartile range, 67.5 months), and all six patients had orbital involvement and intracranial extension of the mass at presentation. They all had surgical debridement, and the specimens were sent for histological examination. Mycological studies carried out on two specimens isolated Aspergillus fumigatusas the fungal agent and all patients were started on post-operative oral antifungal chemotherapy. Five patients completed their chemotherapy and fared well with no recurrence while one patient had irregular and incomplete antifungal treatment, and developed recurrent infection before abandoning further treatment. Conclusion: Chronic invasive fungal sinusitis is an uncommon infection and fairly difficult to manage. However, timely diagnosis and combined surgical and medical treatment can give good outcomes in the patients.