Clinical analysis of acute invasive fungal rhinosinusitis with first manifestation of orbit apex syndrome
Objective To explore the clinical manifestations,early diagnosis and treatment of acute invasive fungal rhinosinusitis(acute invasive fungal rhinosinusitis,AIFRS)with orbit apex syndrome(orbit apex syndrome,OAS)as the first manifestation.Method The clinical data of seven patients with AIFRS with OAS as the first manifestation admitted to our hospital from January 2015 to July 2023 were analyzed retrospectively.Four patients were treated with nasal endoscopic surgery and necrotic tissue cleaning,and intravenous antifungal drug therapy.Three patients were treated intravenous antifungal drug therapy alone.The clinical characteristics,auxiliary examinations,diagnosis and treatment process and prognosis of two typical cases were analyzed emphatically.Reults Among the seven patients,five died,one had no improvement in monocular vision loss,and one had no improvement in binocular vision loss.In seven patients with sinusitis,the mucosa of ethmoid and sphenoid sinus thickened mainly after the disease.The clinical symptoms were not proportional to the sinusitis detected by imaging,and all patients were accompanied by an increase in C-reactive protein.Conclusion AIFRS is a fatal and rapidly developing infectious diseases.The initial clinical manifestation may be only OAS,which is easy to delay treatment.Early identification through clinical symptoms,laboratory and imaging examinations is very important.Early surgical debridement and local and systemic application of sufficient antifungal drugs are the key to improve the prognosis.
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