Endoscopic surgical management of frontal Aspergillus sinusitis with multidrug-resistant staphylococcus epidermidis coinfection complicated by an orbital subperiosteal abscess: A case report

Ha Minh Loi, Nguyen Thi Thanh Minh, Nguyen Van Luan

Main Article Content

Abstract

We report a rare case that was successfully diagnosed and managed at the National Otolaryngology Hospital of Vietnam. The patient presented with Frontal Aspergillus sinusitis complicated by coinfection with multidrug-resistant Staphylococcus epidermidis, resulting in a superior superomedial orbital subperiosteal abscess. The atypical clinical presentation posed significant diagnostic challenges, while the high superomedial location of the abscess made endoscopic surgical management technically demanding, requiring complete removal of the fungal lesion from the frontal sinus together with adequate drainage of the orbital subperiosteal abscess. The patient was successfully treated using a purely endoscopic approach, without requiring an external surgical approach, resulting in a favorable clinical outcome.

Article Details

References

1. Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021 Mar;11(3):213-739. doi: 10.1002/alr.22741
2. Aribandi M, McCoy VA, Bazan C. Imaging features of invasive and noninvasive fungal sinusitis: a review. RadioGraphics, 2007;27(5):1283-1296. doi: 10.1148/rg.27506 5189.
3. Nomura K, Honkura Y, Okumura Y, et al. Frontal Sinusitis with Mixed Bacterial Colonies Treated with the Combination of Endoscopic Modified Lothrop Procedure and External Approach. Case Rep Otolaryngol. 2013;2013:541843. doi: 10.1155/2013/541843
4. Thane Cody D, Bryan Neel H, Ferreiro JA, Roberts GL. Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope. 1994 Sep;104(9):1074-9. doi: 10.1288/00005537-199409000-00005
5. Viola GM, Sutton RD. Allergic fungal sinusitis complicated by fungal brain mass. Int J Infect Dis. 2010 Sep;14 Suppl 3:e299-301. doi: 10.1016/j.ijid.2010.02.2239
6. Kammoun S, Rekik M, Trabelsi H, Neji S, Feki J, Ayadi AJJdmm. Orbital cellulitis secondary to a fungal sinusitis caused by Scopulariopsis: The first case in Tunisia. J Mycol Med. 2018 Jun;28(2):384-386. doi: 10.1016/j.mycmed.2018.04.006
7. Geren BN, Brown HH, Hearnsberger HG, Westfall CO. Allergic fungal sinusitis with unilateral eye involvement. JAMA Ophthalmology. 2004;122;(9):1390-1393. doi:10.1001/archopht.122.9.1390
8. Correll DP, Luzi SA, Nelson BH, pathology n. Allergic fungal sinusitis. Head Neck Pathol. 2015 Dec;9(4):488-91. doi: 10.1007/s12105-014-0598-5
9. Ji J, Roland LT. Invasive fungal rhinosinusitis: current evidence and research opportunities. Curr Opin Otolaryngol Head Neck Surg. 2025 Feb 1;33(1):20-30. doi: 10.1097/MOO.0000000000000993
10. DeShazo RD, Chapin K, Swain REJNEJoM. Fungal sinusitis. N Engl J Med. 1997 Jul 24;337(4):254-9. doi: 10.1056/NEJM199707243370407
11. Schubert M. Medical treatment of allergic fungal sinusitis. Ann Allergy Asthma Immunol. 2000 Aug;85(2):90-7; quiz 97-101. doi: 10.1016/S1081-1206(10)62445-3
12. Schubert M. Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycol. 2009;47 Suppl 1:S324-30. doi: 10.1080/13693780802314809
13. Shafik J, Sangiuolo K, Sheinin E, et al. Postoperative oral corticosteroid use following endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2025 Jul;39(4):322-332. doi: 10.1177/19458924251335075.
14. Rains BM, Mineck CW. Treatment of allergic fungal sinusitis with high-dose itraconazole. Am J Rhinol. 2003 Jan-Feb;17(1):1-8. PMID: 12703478