Invasive fungal rhinosinusitis: experience from a 4-year case series of 49 adult patients at a tertiary hospital in Vietnam.

BACKGROUND

Invasive fungal rhinosinusitis (IFRS) represents a severe infection associated with high morbidity and mortality, particularly among patients with predisposing factors such as diabetes mellitus or recent coronavirus disease 2019 (COVID-19). This study aimed to describe the clinical features and therapeutic outcomes of IFRS in a tertiary care setting in Vietnam.

METHODS

We conducted a descriptive study of 49 adult patients diagnosed with IFRS at the Hospital for Tropical Diseases in Ho Chi Minh City between January 2022 and December 2025. Data on demographics, comorbidities, clinical presentation, imaging, histopathology, and outcomes were analyzed.

RESULTS

The median age was 60 years, and 55.1% of the patients were male. Diabetes mellitus (77.6%) was identified as a significant underlying condition. Common clinical manifestations included craniofacial pain (89.8%) as well as orbital swelling and proptosis (67.3%). Imaging studies demonstrated frequent involvement of the maxillary sinus (73.5%) and ethmoid sinus (67.3%), with orbital invasion observed in 55.1% of patients. Histopathological examination revealed the presence of Mucorales in 55.1% of cases and Aspergillus-like filamentous fungi in 40.8%. All patients underwent surgical intervention and received systemic antifungal therapy. There were four fatal cases during the induction phase; notably, all deceased patients exhibited acute IFRS with intracranial invasion.

CONCLUSION

IFRS predominantly affects individuals with diabetes mellitus and those with a history of COVID-19 in Vietnam. Mucorales is the leading pathogen. Given the rapid progression and risk of intracranial invasion, early diagnosis based on clinical suspicion and a multidisciplinary management strategy are vital for reducing mortality.