SHM Converge Scientific Abstract ePoster Gallery-A Silent Threat Unveiled: Invasive Fungal Sinusitis in High-Risk Patient

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This case report describes invasive fungal sinusitis (IFS) in a 53-year-old man with relapsed acute myeloid leukemia after allogeneic hematopoietic stem cell transplant (HSCT), complicated by graft-versus-host disease and profound neutropenia. He presented with persistent high fevers, frontal headaches, and blood-tinged nasal secretions. Despite standard antimicrobial prophylaxis and escalation of antibiotics, his symptoms progressed to congestion and right orbital edema.<br /><br />Imaging showed worsening sinus disease with orbital extension. Frozen pathology confirmed IFS with concern for mucormycosis, prompting immediate Infectious Diseases consultation and dual antifungal therapy with liposomal amphotericin B and isavuconazonium. He also underwent nasal endoscopy, debridement, and bilateral functional endoscopic sinus surgery. Intraoperative cultures ultimately grew Aspergillus niger.<br /><br />Although he initially improved and was discharged on outpatient isavuconazonium, ongoing neutropenia and progressive fungal disease despite aggressive medical and surgical management led the patient and family to choose hospice care.<br /><br />The report emphasizes that IFS is a rapidly progressive but often subtle and easily missed infection, with mortality rates as high as 80%. Allogeneic HSCT recipients, especially those with prolonged febrile neutropenia, re-induction chemotherapy, or prior GvHD, are at particularly high risk. The authors stress the importance of early recognition, prompt ENT evaluation, multidisciplinary management, surgical debridement, and mold-active antifungal therapy. They also note that antifungal prophylaxis and earlier specialist involvement may improve outcomes in high-risk hematologic malignancy patients.

Asset Subtitle

Elexis B. Price

Meta Tag

Author List Elexis B. Price, Gina Askar, Hasan Samra, Shresttha Dubey, Zoheb Sulaiman

Category Clinical Vignettes

Concept Invasive Fungal Sinusitis

Concept Neutropenia

Concept Systemic Antifungal

Concept Hematologic Malignancy

Concept Stem Cell Transplantation

Distinguished Non-Finalist

Presenter Organization Medical College of Georgia

Presenting Author Elexis B. Price

Track Adult

Keywords

invasive fungal sinusitis

acute myeloid leukemia

allogeneic hematopoietic stem cell transplant

graft-versus-host disease

neutropenia

mucormycosis

Aspergillus niger

liposomal amphotericin B

isavuconazonium

endoscopic sinus surgery

Invasive Fungal Sinusitis

Neutropenia

Systemic Antifungal

Hematologic Malignancy

Stem Cell Transplantation