Acute Invasive Fungal Rhinosinusitis: Insights from a Cohort on Mortality and Surgical Outcomes

Background Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive and aggressive infection, primarily affecting immunocompromised patients. This study aims to characterize the clinical and microbiological findings and assess treatment outcomes in cases with AIFRS. Methods A retrospective observational study was conducted between January 2013 and July 2024. Patients were included based on histopathological confirmation of fungal infection and clinical evidence of AIFRS. Data on demographics, comorbidities, symptoms, imaging, microbiology, treatment, and outcomes were collected. Results Twelve patients were included, with a mean age of 52.3 (± 13.5) years and a predominance of females (9/12). Diabetes mellitus and hematologic malignancies were the most common comorbidities (5 cases each). The most frequent pathogens were Aspergillus spp. (6 cases) and Mucorales spp. (5 cases). The sphenoid and ethmoid sinuses were the most commonly affected (10 cases each). Orbital invasion and cavernous sinus involvement were observed in 9 and 4 cases, respectively. Three patients underwent orbital exenteration and survived. Two patients, with distinct underlying etiologies and fungal pathogens, were treated concomitantly with hyperbaric oxygen therapy, with no reported fatalities. The overall mortality rate was 58.3%, with 41.7% directly attributed to AIFRS. Conclusions AIFRS is associated with high mortality, particularly in immunocompromised patients. Establishing standardized surgical criteria is essential for improving outcomes in cases involving fungal invasion of the orbit. Additionally, hyperbaric oxygen therapy in selected cases with different underlying etiologies or fungal pathogens may contribute to improved survival.