Acute invasive fungal sinusitis caused by mucormycosis at Buddhasothorn Hospital

Abstract

Introduction: Acute invasive fungal sinusitis (AIFS) as caused by mucormycosis, is a fulminant and life-threatening condition with a high mortality rate. The disease progresses rapidly to adjacent structures, including the orbits and central nervous system. Early clinical manifestations are often nonspecific, leading to delayed diagnosis and treatment, which results in a substantial increase in patient morbidity and mortality. No previous studies of this condition have been conducted at Buddhasothorn Hospital.

Objectives: To describe the demographic characteristics, clinical presentations, underlying comorbidities, treatment modalities, clinical outcomes, length of hospital stay, and further complications of patients at Buddhasothorn Hospital diagnosed with AIFS, as caused by mucormycosis

Methods: Data from all cases diagnosed with AIFS due to mucormycosis between 2017 and 2025 at Buddhasothorn Hospital were retrospectively collected. Because of the rarity of the disease, only 6 eligible cases identified from the hospital database were included.

Results: All cases were male with a mean age of 55 (2.22) years. Diabetes mellitus was the most common underlying comorbidity, presented in 4 of the 6 cases (66.67%). Mucorales infections were isolated and identified in 83.33% of cases. The ethmoid and maxillary sinuses were the most frequently involved of the paranasal sinuses (83.33%). The median interval from symptom onset to initiation of treatment was 10.00 days (range, 6.25–12.25). Ocular symptoms were the most common complaint, occurring in 50% of patients. The most frequently involved extra-sinonasal site was the orbit. All patients received systemic amphotericin B in combination with the surgical debridement of the affected sinuses and adjacent structures. The median duration of antifungal therapy was 52.00 days (range, 41.25–107.00). One patient died (16.67%).
No disease recurrence was observed among survivors upon hospital discharge.

Conclusions: Most cases at Buddhasothorn Hospital of patients with AIFS as caused by mucormycosis had diabetes mellitus as an underlying comorbidity. The most common
initial presentation was ocular. The ethmoid and maxillary sinuses were the most frequently affected sites, often extending to the orbits. Despite standard management, including surgical debridement and systemic antifungal therapy, the mortality rate was 16.67%.