3.2 Detailed therapeutic strategies were made case by case.
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.
Follow up and recovery
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).