Invasive fungal sinusitis

Microbiology

• Mucorales (50%)
• Aspergillus (50%)
• Fusarium (rare)

Clinical Presentation

• Difficult to distinguish from bacteria
• Risk factors: DM, solid organ transplant, hematologic transplant
• Edema and paresthesias are common
• NP scope normal in ~30%; black eschar in 50%

Management

• CT for extrasinus invasion
  • MRI is more sensitive
• Debridement
• Lipsomal amphotericin B 5 mg/kg
  • Every day of delay increases mortality
  • 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months
• Decrease immunosuppression