Successful treatment of invasive Aspergillus sinusitis with caspofungin and voriconazole

by Lisa Chirch, MD, Patricia Roche, DO, and Jack Fuhrer, MD | Tuesday, January 01, 2008

IntroductionFungal sinusitis is classified as invasive or noninvasive and chronic or acute.1Acute invasive fungal rhinosinusitis occurs more often in immunocompromised patients, and symptoms develop rapidly over days to weeks. Chronic invasive fungal sinusitis occurs in patients with little or no evidence of immunocompromise, and it tends to present more insidiously over weeks to months.1 The prognosis generally depends more on the host's immune status than on the specific causative organism.Traditionally, invasive Aspergillus sinusitis has been treated with extensive surgical debridement followed by long-term antifungal therapy, primarily with intravenous amphotericin B. We describe a case in which the patient's fragile condition and refusal to undergo surgery necessitated a novel approach to therapy.Case reportAn 89-year-old woman with asthma presented to our hospital with a 1-year history of facial and tooth pain and a runny nose. Both her dentist and her primary care physician had .../continued/

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