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Invasive Aspergillus terreus sinusitis with orbitocranial extension: case report
Ali Akhaddar1, Miloudi Gazzaz, Abderrahmane Albouzidi
1Department of Neurosurgery, Mohammed V Military Hospital, Rabat, Morocco. akhaddar@hotmail.fr
Surgical Neurology
|February 12, 2008
Summary
Invasive Aspergillus terreus sphenoid sinusitis with orbitocranial extension is rare, even in immunocompetent patients. Early diagnosis and treatment are crucial for managing this challenging fungal infection.
Area of Science:
- Otorhinolaryngology
- Infectious Diseases
- Medical Mycology
Background:
- Paranasal sinus aspergillosis is uncommon, typically caused by Aspergillus fumigatus or A. flavus, often affecting the maxillary sinus.
- Invasive cranio-orbital aspergillosis originating in the sphenoid sinus is rare, predominantly seen in immunocompromised individuals with poor prognoses.
Observation:
- A 62-year-old immunocompetent male presented with retroorbital pain, vision loss, and epistaxis.
- Imaging revealed a sphenoid sinus lesion with bone destruction and intraorbital/cavernous sinus extension, initially suspected as a malignancy.
Findings:
- Histopathology confirmed invasive Aspergillus terreus sinusitis, with no evidence of systemic infection or immunosuppression.
- Treatment with oral voriconazole led to regression of the orbitocranial mass and clinical improvement.
Implications:
- This case represents the first reported instance of A. terreus sinusitis with orbitocranial extension in an immunocompetent host.
- Invasive sphenoid aspergillosis (ISOA) poses significant challenges due to intracranial extension and potential antifungal resistance, necessitating early diagnosis and intervention.
