Cleveland Clinic Abu Dhabi saves vision for patient with rare invasive fungal sinusitis using advanced skull-base surgery

• Timely diagnosis and advanced skull base surgery preserved the patient’s vision, avoided eye removal and averted life-threatening complications. • Cleveland Clinic Abu Dhabi’s multidisciplinary approach and cutting-edge therapies enabled successful treatment of a rare invasive fungal sinusitis.

Cleveland Clinic Abu Dhabi, part of the M42 group, successfully saved a 57-year-old woman’s eye from a rare and invasive fungal sinusitis through an extensive skull base surgery, preventing the need for orbital exenteration (eye removal).

The patient had previously undergone bilateral sinus surgery at a different hospital, which led to post-operative maxillary sinusitis - a condition where the sinuses behind the cheeks became infected or inflamed after the procedure. She was later admitted to the Emergency Department of Cleveland Clinic Abu Dhabi with severe right-sided facial pain and swelling. Despite initial treatment with antibiotics and steroids, her condition deteriorated, leading to nasal congestion, changes in her sense of smell, and debilitating headaches.

Further investigation, including an MRI, revealed mucosal thickening and a breakthrough in the thin bone separating her sinuses and orbital cavity, which caused the infection to get dangerously close to her eye and potentially spread further. A swab of the affected area confirmed an invasive fungal infection caused by Aspergillus; an infection caused by a type of fungus. If left untreated, the infection would have invaded deeper tissues of the orbit and possibly spread to nearby structures such as the brain, posing a significant threat to her life.

A multidisciplinary team led by Dr. Mahdi Shkoukani, Department Chair for Otolaryngology Head & Neck Surgery in the Surgical Subspecialties Institute at Cleveland Clinic Abu Dhabi, quickly recognized the urgency of the patient’s condition. They performed an extensive surgical debridement to remove the infected tissue, including parts of the sinuses, the medial orbital wall, and the orbital fat around the eye.

Explaining the complex nature of the condition, Dr. Mahdi Shkoukani said: “This was one of the rarest cases of sinusitis we encountered in recent years. Despite the patient being healthy and having a functioning immune system, the patient’s fungal infection had progressed to a point where it posed a serious threat to her eye and brain if left untreated. The case underscores the importance of early diagnosis and rapid surgical and medical intervention for invasive fungal sinusitis. Through a complex and meticulous surgical procedure, we successfully removed all the infected tissue while preserving her vision. The multidisciplinary teamwork at Cleveland Clinic Abu Dhabi played a crucial role in achieving this positive outcome. We hope this story raises awareness about the severity of such infections and the importance of seeking immediate medical attention when symptoms persist or worsen.”

Following surgery, the patient’s infection subsided, and her tissues began to heal. A second procedure two days later confirmed no further fungal invasion, sparing her from orbital exenteration. She was started on antifungal medications from day one when we first suspected the infection and was closely managed by the infectious disease team. Today, her sinuses have healed and her vision remains intact.

Dr. Shkoukani commented further: “Fungi are typically harmless and naturally present in the sinuses. However, in certain conditions, they can become aggressive, spreading to surrounding tissues, including the eyes and brain. In patients with compromised immune systems, this invasion can progress rapidly, leading to a condition known as acute invasive fungal sinusitis. In immune-competent individuals, like our patient, the progression is usually slower, resulting in chronic invasive sinusitis. At Cleveland Clinic Abu Dhabi, our advanced facilities and multidisciplinary expertise enable us to manage such complex cases with precision and care.”

Reflecting on her journey, the patient shared: “I’m incredibly grateful to the team at Cleveland Clinic Abu Dhabi for their swift action and expertise. It was a terrifying experience to think I might lose my eye, but their dedication and skill saved me. I never imagined something like a sinus infection could become so dangerous, and I hope my story encourages others to seek help early if they have persistent symptoms.”

This case, out of many, underscores Cleveland Clinic Abu Dhabi’s expertise in complex care and its commitment to innovation and patient-centered care. The hospital continues to make a transformative impact in the lives of patients with world-class care. The hospital’s Integrated Surgical Institute combines cutting-edge diagnostics and surgical expertise to address complex cases like this. Raising public awareness about symptoms such as persistent facial pain and swelling, coupled with early medical intervention, can prevent severe complications.

For more information or to book an appointment at Cleveland Clinic Abu Dhabi, call 800 8 CCAD (2223) visit www.clevelandclinicabudhabi.ae or download the Cleveland Clinic Abu Dhabi Patient Portal App.