All 8 patients had severe immunocompromised disease, i.e. poorly
controlled diabetes, malignant hematological diseases, cancer (advanced
stage) undergoing chemotherapy afflicted with granulocytopenia, renal
insufficiency. The primary and main symptoms were severe headache,
progressive eye disorder, facial pain. Because of severe underlying
disease, 7/8 patients firstly admitted to corresponding department,
after multi-disciplinary treatment (MDT) consultation, they were
transferred to ENT department (table 1).
Radiological features: computed tomography (CT) and magnetic resonance
imaging (MRI) were used preoperatively to determine the extent of fungal
invasion, all patients showed extra-sinus
dissemination: orbit and orbital
apex(5/8), cavernous sinus(2/8), face(3/8), palate(2/8). 6/8 patients
had unilateral involvement and 2 patients with bilateral involvement. CT
often showed heterogeneous opacity with or without bone erosion. MR
usually showed a relative hypointense signal in T2W1 compared with
bacterial inflammation, and an uneven enhancement in enhanced
T1-weighted image. The main radiological findings with CT/MRI and
endoscopic findings were summarized in Fig1-2 and supplementary Fig1-4
respectively.
Based on an immunosuppressive history, rapid spread of
orbit-cranial-face invasion, and radiological features, all cases were
suspicion as AFIRS at first glance. Among them, 6 cases were
pathologically confirmed after operation, 1 case was microbiological
confirmed as Rhizopus and the other one evidenced by gross sign of mucor
growth.