Get access

Chronic granulomatous invasive fungal sinusitis: an evolving approach to management

Authors

  • Ashleigh Halderman MD,

    1. Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, OH
    Search for more papers by this author
  • Rabin Shrestha MBBS, MPH,

    1. Section of Infectious Disease, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
    Search for more papers by this author
  • Raj Sindwani MD, FACS, FRCSC

    Corresponding author
    1. Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, OH
    • Correspondence to: Raj Sindwani, MD, Head & Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, A-71, Cleveland, OH 44195; e-mail: Sindwar@ccf.org

    Search for more papers by this author

  • Potential conflict of interest: None provided.

  • Presented as a poster at the 2013 Combined Otolaryngologic Spring Meeting on April 12, 2013, Orlando, FL.

Abstract

Background

Chronic granulomatous invasive fungal sinusitis (CGIFS) is rare and a consensus on ideal management is lacking. We present an extensive case managed successfully with a conservative approach.

Methods

Case report and literature review.

Results

The patient presented with unilateral proptosis, papilledema, and headache. Imaging revealed an infiltrative process with extensive intracranial and intraorbital involvement. Biopsy showed fungal elements and granulomatous reaction consistent with CGIFS. The patient was managed with conservative surgery and long-term oral voriconazole.

Conclusion

This case supports a conservative surgical approach in some patients with extensive CGIFS. Oral voriconazole is effective and has significant advantages over more toxic agents administered intravenously.

Ancillary