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Introduction: Invasive fungal rhinosinusitis (IFRS) often manifests in immunocompromised individuals and is challenging to manage. This study sets out to identify outcomes of pediatric patients who have undergone biopsy for suspected IFRS relative to a comparable general population.

Methods: This is a single-site three arm retrospective review of patients diagnosed with suspected IFRS and control patients between January 1, 1995 and April 1, 2019. This review analyzed patients who have received a diagnosis of ALL, AML, NHL, aplastic anemia, or who received an allogeneic BMT during the study period. Qualifying patients aged 21 years old and younger were assigned into one of three groups within the study: an IFRS positive biopsy group, an IFRS negative biopsy group, or a comparable general population group. Patients who had undergone endoscopic surgery due to suspicion of IFRS were included in one of the two IFRS groups. A total of 804 patients were included in this study. Data collected for this study included results of biopsies if conducted, cause of death in patients who received biopsies, and mortality of all patients.

Results: The presence of a positive biopsy for IFRS did not meaningfully affect the mortality rate of pediatric patients relative to those who underwent a biopsy that was negative for IFRS. However, pediatric patients who underwent a biopsy for IFRS—regardless of the outcome of the biopsy—had a higher mortality rate than the comparable general population of pediatric patients (p < 0.05).

Conclusions: Patients who undergo biopsy for suspected IFRS are found to have a higher mortality rate than those of a comparable general population, regardless of the outcome of the biopsy. Additionally, the outcomes of pediatric patients with a positive biopsy for IFRS in this study appeared to better than those in adult counterpart studies. Further studies are being conducted to establish criteria for biopsy in suspected IFRS, which can possibly predict patient mortality and guide clinical decision making.

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Outcomes Of Pediatric Patients With Invasive Fungal Rhinosinusitis