An Approach to Fulminant Invasive Fungal Rhinosinusitis in the Immunocompromised Host

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Abstract
INVASIVE FUNGAL sinusitis is a well-described clinical entity characterized by the mucosal infiltration of mycotic organisms and angiocentric extension into orbital and intracranial structures.1-9 Invasive fungal disease of the nose is less frequently discussed especially as it relates to the pathogenesis of fungal sinusitis. A better understanding of the clinical and pathologic spectrum of invasive fungal disease in the sinonasal region may lend insight into the pathogenesis of this deadly disease. The population at risk for invasive fungal rhinosinusitis is growing with the increased prevalence of human immunodeficiency virus disease and the increased use of immunosuppressive therapies.3,10 Invasive fungal rhinosinusitis continues to be lethal in 50% to 80% of cases,11 which necessitates a better understanding of the pathogenesis of the disease to make a more timely diagnosis and institute a more effective treatment regimen.