Characteristics of Clinically Invasive Aspergillosis in Sphenoid Sinus

ABSTRACT

BACKGROUND AND OBJECTIVES: Because of the close vicinity of the orbit to the sphenoid sinus, invasive fungal sphenoiditis is a difficult disorder to correctly diagnose and treat. The aims of this study were to examine clinical characteristics of invasive sphenoidal aspergillosis and to discuss diagnostic and therapeutic priorities. MATERIALS AND METHODS: Eleven patients who presented with sphenoidal aspergillosis in our department since 1997 were reviewed retrospectively. These patients were classified into two groups:a clinically invasive group who experienced aggravation even after endoscopic surgery and required further treatments, including antifungal agent, and a non-invasive group who were cured after surgery. The presenting symptoms, age, underlying systemic diseases, CT and MRI findings, treatment modality, and prognosis were reviewed between the clinically-invasive fungal and non invasive groups. RESULT: Only the clinically invasive group presented with visual disturbance. Visual disturbance developed rapidly within several days. Age over 50 years and diabetes may be associated with visual disturbance. Bony erosion and expanding lesions upon CT or MRI were observed more frequently in the clinically invasive group than in the non-invasive group. Enhancement outside the sphenoid sinus was demonstrated only in the clinically invasive group. Endoscopic sinus surgery was performed with additional amphoterichin B and/or mega-dose steroid therapy. Recovery from visual disturbance was poor. Moreover, mega-dose steroid therapy had no effect on symptoms and caused two complications, uncontrolled diabetes and pneumonia. CONCLUSION: Aged diabetic patients, rapidly progressing eye symptoms, bony erosion, and expanding sphenoid lesions upon imaging incur high suspicion of invasiveness in a sphenoid fungus ball. Endoscopic sinus surgery to remove sphenoid fungus balls, as well as systemic antifungal treatment, should be started as early as possible in patients with these clinical features.