Diagnosis
Acute invasive fungal sinusitis
An invasive fungal sinus infection that usually occurs in an immunocompromised (HIV/AIDS, diabetic) host. It is a medical emergency with high mortality rate (50-80%) [abt].
Also known as: Acute invasive fungal rhinosinusitis, Fulminant invasive fungal sinusitis, Mucormycosis, Zygomycosis
Etiology
Cause [abt]
Aspergillus species
Zygomycetes (Mucor, Rhizopus, Rhizomucor)
Pathophysiology [vgo]
The immune fitness of the individual often plays a more central role in determining whether those atmospheric fungi lead to the pathology of the sinuses or not
Risk factors
Immune suppressants
Antibiotics
Chronic diseases that suppress the immune system (diabetes)
Chemotherapy
Classification [vgo]
Non-invasive fungal sinusitis:
Fungal ball
Saprophytic fungal sinusitis
Allergic fungal rhinosinusitis
Invasive fungal sinusitis:
Acute invasive rhinosinusitis
Chronic invasive rhinosinusitis
Granulomatous invasive sinusitis
Epidemiology
Incidence per 100.000 [7ru]
Symptoms & findings
Symptoms
Anopsia, Anosmia, Epistaxis, Fever, Headache, Nasal congestion, Ophthalmoplegia, Post-nasal drip, Pruritus, Rhinorrhea, Sneezing
Clinical findings
None listed.
Anamneses
None listed.
Localized findings
Approach
Maxillary sinus aspiration
Biopsy
CT caput
Treatment
Reversal of immunosuppression
Immune-stimulating therapies / Fungal immunotherapy
Surgery: débridement of necrotic tissue and to clear the burden of fungal elements [vgo]
Oral corticosteroids
Antifungal therapy (Amphotericin B if Mucor species and Aspergillus)
Differential diagnoses
Acute sinusitis, Allergic rhinosinusitis, Cancer, Chronic sinusitis, Immunodeficiency, Sarcoidosis, Wegener's granulomatosis
References
[1] Deutsch PG, Whittaker J, Prasad S. Invasive and Non-Invasive Fungal Rhinosinusitis-A Review and Update of the Evidence. Medicina (Kaunas). 2019 Jun 28;55(7):319.
[2] Akhondi H, Woldemariam B, Rajasurya V. Fungal Sinusitis. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551496/
[3] Shintani-Smith et al. Acute invasive fungal sinusitis: Epidemiology and outcomes in the United States. Int Forum Allergy Rhinol. 2022 Feb;12(2):233-236.
[4] Gonzalez et al. Acute Invasive Fungal Sinusitis: A 30-Year Review of Pathology Practice and Possible Utility of the DiffQuik® Stain. Head Neck Pathol. 2021 Sep;15(3):852-858.
[5] Turner et al. Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope. 2013 May;123(5):1112-8.