(086) Chronic Invasive Fungal Sinusitis Mimicking a Sinonasal Malignancy

Introduction: Chronic invasive fungal sinusitis (CIFS) is a rare form of invasive fungal sinusitis which affects the sinonasal cavity and surrounding soft tissues. The prevalence of CIFS is increasing and this has been attributed to the long-term use of steroids and the increase in immunocompromised populations such as those with diabetes or organ transplants. However, it is relatively rare for CIFS to affect immunocompetent individuals. Here we present a case of an immunocompetent patient who presented with a nasopharyngeal and sphenoid mass which mimicked a malignancy leading to difficulty in initial diagnosis.

Methods: The authors present a case of an immunocompetent patient who developed CIFS. Additionally, a comprehensive literature review was performed.

Results: Our study documents a 78-year-old male with a nasopharyngeal and sphenoid sinus mass who underwent two biopsies. His second biopsy showed CIFS. He underwent endoscopic sinus surgery which included a sphenoid drill out and dissection of the pterygopalatine fossa, infratemporal fossa, and nasopharynx to base of the clivus. He is doing well postoperatively. While there are individual case reports which associate CIFS with either cocaine use, facial trauma, or pregnancy, most of the case reports published on immunocompetent CIFS patients describe no obvious etiologies.

Conclusions: This case highlights that CIFS can affect immunocompetent patients and can mimic a nasal mass on initial evaluation which may lead to difficulty in initial diagnosis. The literature suggests that while immunosuppressing conditions are commonly associated with CIFS, immunocompetent patients can also develop this infection and it should be on the differential diagnosis of a sinonasal mass.