International Journal of Otorhinolaryngology and Head and Neck Surgery | August 2020 | Vol 6 | Issue 8 Page 1417 International Journal of Otorhinolaryngology and Head and Neck Surgery Asoegwu CN et al. Int J Otorhinolaryngol Head Neck Surg. 2020 Aug;6(8):1417-1424 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 Original Research Article Chronic granulomatous invasive fungal rhinosinusitis in Nigeria: challenges of management Chinyere N. Asoegwu 1,4 *, Rita O. Oladele 2,4 , Okezie O. Kanu 3,4 , Clement C. Nwawolo 1,4 INTRODUCTION Invasive fungal rhinosinusitis (IFRS) is defined as rhinosinusitis caused by fungal infection with the invasion of the mucosa, submucosa and underlying structures by fungal hyphae. It is classified into acute invasive fungal rhinosinusitis (AIFRS) and chronic invasive fungal rhinosinusitis (CIFRS) based on the duration of the disease. CIFRS is divided into chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) and chronic non-granulomatous invasive fungal rhinosinusitis (CNGIFRS). 1,2 CGIFRS is uncommon and is rarely reported among Caucasians. It affects mostly immunocompetent patients predominantly in countries with tropical climates such as South East Asia and North Africa and South-Western states of USA. 3-6 Aspergillus flavus is the most commonly isolated pathogen of CGIFRS in some tropical countries such as India, ABSTRACT Background: Chronic granulomatous invasive fungal rhinosinusitis affects mainly immunocompetent patients and has been widely reported in tropical regions such as South East Asia and North Africa. Nigeria has a tropical climate, however, there is paucity of data on this disease condition in Nigeria. This study documents the clinical, diagnostic, therapeutic challenges of managing patients with this condition in Nigeria. Methods: A retrospective study of patients diagnosed and treated for chronic granulomatous invasive fungal rhinosinusitis between 2010 and 2019. Diagnosis was based on clinical presentation, computed tomographic scan findings and confirmed by histopathology and/or microbiology results. Results: Ten patients aged 12 to 49 years with mean age of 33.9±13.8 years were studied. Male to female ratio was 2.3:1. All were immunocompetent. Duration of symptoms before presentation ranged from 3 months to 8 years with a mean duration of 3.5±2.4 years. Commonest clinical presentation was unilateral proptosis 80% followed by nasal mass 50%. Commonest sinus involved was the ethmoid (80%). There was orbital extension in 70% and intracranial involvement in 50%. Aspergillus species was the commonest fungal agent cultured. Treatment was by surgical excision followed by antifungal drugs. Some of the challenges we encountered in the management included; late presentation, delay in diagnosis, limited experience in histopathologic and mycology diagnosis and high cost of treatment amidst scarce resource. Conclusions: Chronic invasive granulomatous rhinosinusitis is not rare in Nigeria. A high index of suspicion is however needed for the diagnosis. Development of a National management protocol for this disease is recommended to avoid misdiagnosis. Keywords: Granulomatous invasive fungal-rhinosinusitis, Nigeria, Aspergillus-species, Antifungal agents 1 Division of Otorhinolaryngology, Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria 2 Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria 3 Division of Neurosurgery, Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria 4 Lagos University Teaching Hospital, Lagos, Nigeria Received: 07 June 2020 Accepted: 09 July 2020 *Correspondence: Dr. Chinyere N. Asoegwu, E-mail: casoegwu@unilag.edu.ng Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20203189