Nishimura Haruka, Maruyama Ryo, Yatomi Masanori, Tsukahara Kiyoaki
Otolaryngology - Head and Neck Surgery, Tokyo Medical University, Tokyo, JPN.
Cureus. 2024 Nov 17;16(11):e73868. doi: 10.7759/cureus.73868. eCollection 2024 Nov.
Invasive fungal rhinosinusitis can be fatal if it spreads from the orbit to the cranium. The primary treatment involves thorough lesion debridement; however, complete removal may be challenging in cases involving intracranial extension. Here, we report a case of invasive fungal rhinosinusitis with intracranial and orbital invasion successfully managed with maximal surgical debridement and antifungal therapy. The patient was a 59-year-old man with untreated diabetes mellitus who had experienced a gradual decrease in right-eye vision over the past month. He sought medical attention at a local hospital and was referred to our hospital for further examination. Computed tomography and magnetic resonance imaging scans revealed a soft tissue mass with accompanying bone destruction extending to the tip of the right orbit. Inflammation had spread to the dura mater, and cavernous sinus invasion was also observed. A biopsy was performed under endoscopy, and invasive fungal rhinosinusitis due to Aspergillus was diagnosed. We started treatment with the antifungal agent voriconazole (VRCZ), and 12 days after the biopsy, we performed endoscopic sinus surgery for debridement, removing as much of the lesion as possible. We decided to continue conservative treatment with VRCZ for the residual lesion. Two years postoperatively, the fungal lesion has maintained a reduced size. In this case, complete removal of the lesion was challenging; however, the present case suggests that disease control is possible by removing as much of the lesion as possible and administering VRCZ.
侵袭性真菌性鼻-鼻窦炎若从眼眶蔓延至颅骨可导致死亡。主要治疗方法包括彻底的病灶清创；然而，在涉及颅内扩展的病例中，完全切除可能具有挑战性。在此，我们报告一例侵袭性真菌性鼻-鼻窦炎伴颅内和眼眶侵犯的病例，通过最大程度的手术清创和抗真菌治疗成功治愈。患者为一名59岁男性，患有未经治疗的糖尿病，在过去一个月中右眼视力逐渐下降。他在当地医院就诊，后被转诊至我院进一步检查。计算机断层扫描和磁共振成像扫描显示有一个软组织肿块，伴有骨质破坏，延伸至右眼眶尖部。炎症已蔓延至硬脑膜，还观察到海绵窦侵犯。在内镜下进行了活检，诊断为曲霉菌性侵袭性真菌性鼻-鼻窦炎。我们开始使用抗真菌药物伏立康唑（VRCZ）进行治疗，活检后12天，我们进行了内镜鼻窦手术清创，尽可能多地切除病灶。对于残留病灶，我们决定继续使用VRCZ进行保守治疗。术后两年，真菌病灶体积持续缩小。在该病例中，完全切除病灶具有挑战性；然而，本病例表明，通过尽可能多地切除病灶并给予VRCZ，疾病控制是可行的。
