RESUMO
BACKGROUND: Early diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. This study evaluated the impact of a systematic protocol with nasal endoscopy and biopsies to early detect AIFRS in immunocompromised patients. Additionally, we compared the accuracy of frozen-section biopsy and culture with formalin-fixed paraffin-embedded (FFPE) biopsy. METHODS: Retrospective cohort in a Tertiary Referral Hospital. Patients with the suspected diagnosis of AIFRS were evaluated following a standardized protocol, including serial nasal endoscopies and biopsies when necessary. The sensitivity and specificity of frozen-section biopsy and culture were also compared with FFPE. RESULTS: The mortality rate related to AIFRS of this standardized cohort (13/43) was 30.2%. Better outcomes were observed in patients with disease limited to the turbinates and in those with higher peripheral neutrophils count. Frozen-section biopsy positivity correlated with FFPE findings for fungi detection (p-value < 0.0001), with a sensitivity of 90.6%, specificity of 72.7%, and accuracy of 86.0%. CONCLUSION: Implementation of this standardized protocol was related to a considerably low mortality rate among patients with suspected AIFRS at our Institution. Frozen-section biopsy revealed high accuracy to diagnose AIFRS. The current protocol including frozen-tissue biopsy improved the evaluation and survival rates of immunocompromised patients with presumed AIFRS.
Assuntos
Biópsia/métodos , Endoscopia/métodos , Infecções Fúngicas Invasivas/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Secções Congeladas , Humanos , Hospedeiro Imunocomprometido , Lactente , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/mortalidade , Masculino , Pessoa de Meia-Idade , Nariz , Inclusão em Parafina , Estudos Retrospectivos , Rinite/microbiologia , Rinite/mortalidade , Sensibilidade e Especificidade , Sinusite/microbiologia , Sinusite/mortalidade , Taxa de SobrevidaRESUMO
Meningoencefalocele intranasal é uma afecçäo rara, principalmente em adultos. O caso apresentado mostra uma grande massa que ocupava toda a fossa nasal direita e deslocava o septo inteiramente para o lado oposto. Submetido a tratamento cirúrgico por rinotomia lateral, o paciente evolui satisfatoriamente e assintomático há três anos
