Concurrent diagnosis of sinus fungus ball and invasive fungal sinusitis: A retrospective case series

Abstract

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.

Clinical Characteristics of Sphenoid Sinus Fungus Ball: A Nine‐year Retrospective Study of 77 Cases

“…These patients may be in danger because SSFB cannot be discovered without CT scans. FB may progress insidiously to invasive fungal sinusitis in patients who have concurrent diabetes with poor glycemic control 4 . Ten patients in our series had diabetes, which was regarded as a risk factor for FB development in some oppions 26 .…”

“…Invasive fungal sinusitis is more likely to develop in immunocompromised patients, whereas the non‐invasive form happens more in immunocompetent patients 2,3 . Fungus ball (FB) is a relatively benign form of fungal sinusitis and is most frequently affected in maxillary sinus, followed by sphenoid sinus 4 . The symptoms of sphenoid sinus fungus ball (SSFB) are often non‐specific, and the common complaints are headache, nasal obstruction, and postnasal drip according to the literature 5 …”

“…2,3 Fungus ball (FB) is a relatively benign form of fungal sinusitis and is most frequently affected in maxillary sinus, followed by sphenoid sinus. 4 The symptoms of sphenoid sinus fungus ball (SSFB) are often non-specific, and the common complaints are headache, nasal obstruction, and postnasal drip according to the literature. 5 Diagnosis of SSFB relies on computed tomography (CT) and magnetic resonance imaging (MRI).…”

Comprehensive management of paranasal sinus fungus balls: A Young‐IFOS consensus statement

“…The latter should be reserved for evaluating differential diagnoses or invasive behaviors that have been occasionally described. 10 A more disputed issue, although reaching consensus, was delineating the role of PSFB accompanied by endoscopic findings of purulence, edema, or polyps and involvement of more than 1 paranasal, which were deemed signs of secondary sinusitis with bacterial superinfection, obstructive rhinosinusitis, or evolution toward invasive forms, as the literature indicates that PSFB should not be characterized by purulence or bacterial superinfection per se. 11 Literature reports suggest that bacterial superinfection may characterize more symptomatic cases, as well as all cases of PSFB with underlying odontogenic sinusitis.…”

“…Typical CT findings (an iron‐like core; ie, foci of calcific deposits mimicking a metallic foreign body inside the sinus—or surrounding bone hyperostosis) and MR characteristics (T2 signal void) strengthen a PSFB diagnosis and do not require administration of contrast medium. The latter should be reserved for evaluating differential diagnoses or invasive behaviors that have been occasionally described 10 . A more disputed issue, although reaching consensus, was delineating the role of PSFB accompanied by endoscopic findings of purulence, edema, or polyps and involvement of more than 1 paranasal, which were deemed signs of secondary sinusitis with bacterial superinfection, obstructive rhinosinusitis, or evolution toward invasive forms, as the literature indicates that PSFB should not be characterized by purulence or bacterial superinfection per se 11 .…”