Acute Invasive Fungal Rhinosinusitis: An Integrated Review of ENT, Internal Medicine and Radiology

Abstract

Acute invasive fungal rhinosinusitis (AIFR) is a rapidly progressive and potentially fatal infection characterized by fungal invasion of sinonasal tissue and blood vessels, predominantly affecting patients with impaired host defenses. Diabetes mellitus, diabetic ketoacidosis, hematological malignancy, prolonged neutropenia, transplantation, and corticosteroid-mediated immunosuppression are major predisposing conditions. The disease requires simultaneous contributions from otorhinolaryngology, internal medicine, infectious diseases, hematology, endocrinology, and radiology. ENT provides recognition of suspicious mucosa, urgent tissue diagnosis, and serial surgical debridement. Medicine identifies and reverses systemic conditions that permit fungal invasion, initiates organism-appropriate systemic antifungal therapy, and manages metabolic and hematological abnormalities. Radiology defines the true extent of disease because vascular and perivascular spread may extend beyond the paranasal sinuses before obvious osseous destruction develops. CT is useful for sinonasal anatomy and bone; contrast-enhanced MRI is particularly valuable for devitalized mucosa, perisinus spread, orbital involvement, cavernous sinus disease, vascular complications, and intracranial extension. Literature from 2011-2016 supports a combined strategy of rapid recognition, tissue confirmation, aggressive surgical debridement, immediate systemic antifungal therapy, reversal of predisposing abnormalities, and imaging-guided assessment of disease extent.