In principle, surgical debridement
and antifungal agents remained
the two cornerstones of AIFRS treatment, and what’s more, it should be
performed as soon as possible when diagnosis preliminary made. However,
because of severe underlying disease for these patients, detailed
therapeutic schedule were made case by case. In this group of 8 cases, 6
patients underwent endoscopic debridement with endoscopic surgery (ESS),
most under general anesthesia except one, removal of necrotic tissue as
much as possible according to CT/MR. However, for some region, such as
orbital apex, cavernous sinus, it was difficult to be completely
debrided, detailed information was listed in table3. The other two (6#
and 8#) were contraindication to an operation because of poor general
condition under chemotherapy and a rapid disastrous spread.
All patients were given sensitive antifungal drugs when AIFRS diagnosis
made. voriconazole 200mg Q12h for Aspergillus, amphotericin B or
amphotericin B liposome and/or
posaconazole for mucor was the
first choice. Dose and duration were scheduled case by case (detailed in
table2). All patients were given broad-spectrum antibiotics and
symptomatic supportive treatment during hospitalization.
Those patients were followed up for 10 days to 58 months, except 2# and
7# cured, 4# still under control with oral Posaconazole intake, the
remaining 5 patients died. Duration from the patient’s diagnosis to
death ranged from 10d to 50m (10d, 1m, 2m, 2.5m and 50m respectively),
mainly died of multiple organ failure (MOF) and uncontrolled infection
(detailed in table2).