Invasive Fungal Sinusitis in Neutropenic Patients: A Case Report and Literature Review

Introduction: Acute invasive fungal rhinosinusitis is uncommon, potentially lethal, being opportunistic infection seen mainly in diabetics and immunocompromised individuals. It is one form of infection that appears to be increasing in frequency? The classification is based on the immunological relationship between fungus and host and existing invasive and noninvasive forms. Acute fulminant fungal sinusitis is usually found in neutropenic patients with cancer of lymphoreticular or hematopoietic systems and has invasion of blood vessels character. In this group, aspergillosis is responsible for more than 80% of infections, especially Aspergillus fumigatus. The treatment is surgery with wide debridement, systemic antifungal drugs, and correction of underlying metabolic or immunologic disorders.

Objective: This study aims to report a case of a patient with leukemia who developed invasive fungal sinusitis and correlate with the literature.

Case Report: A female patient, chemotherapy-induced neutropenia presents facial pain, nasal congestion, and fever unresponsive to broad-spectrum antibiotics. Nasal endoscopy observed necrotic lesion in the inferior turbinate. Cultures of the biopsy specimen that confirmed the presence of hyphal and histopathological studies show hyphal invasion of blood vessels. Endoscopic sinus surgical approach with debridement of the necrotic area, an empiric antifungal therapy and restoration of immunity function, was submitted.

Conclusion: Invasive fungal rhinosinusitis is characterized by high morbidity and mortality. So, there is a favorable patient outcome, it is fundamental to rapid diagnosis with immediate initiation of therapy, that mandatorily includes the surgical approach.