Chronic Invasive Fungal Sinusitis: Diagnosis & Management

[Dr. Ashley Agan]
In patients who are presenting with predominantly like a facial pain complaint, I feel like it would be very easy to miss this because it's so rare that most of us probably aren't thinking of chronic invasive. Because patients coming in with sinus headache and facial pain are pretty common, and the percentage of them that are experiencing a chronic invasive fungal sinusitis is probably very, very low. Also you don't want to miss this. Any other questions that help tip you off, or is it just the chronic worsening nature of it? Walk me through your clinic visit to where we can make sure that we're catching these. Because these are mostly presenting in the clinic, not in the hospital, like an acute, right?

[Dr. Ashleigh Halderman]
No. The ones that I've seen have all presented in the hospital actually. It's because unfortunately by the time they get to us is they've gone blind, or they've developed some type of orbital symptoms, if you will, or the imaging is very concerning for like a mass or a tumor. That's how they typically end up with us. If you were just going off of facial pain alone, it is difficult and you're right, the majority of those patients are not going to have chronic invasive fungal sinusitis. Again, if they don't have any possible immune deficiency, like they're not diabetic, they haven't been on steroids, all of these things, then that further sort of is like probably not the case.