Scedosporium apiospermum invasive sinusitis presenting as extradural abscess

Area of Science:

• Mycology
• Infectious Diseases
• Otolaryngology

Background:

• Chronic invasive fungal rhinosinusitis (CIFR) is rare, typically affecting immunocompromised individuals.
• Aspergillus species are the most common pathogens identified in CIFR.
• Imaging in CIFR often shows invasive pseudoneoplastic features.

Observation:

• A 72-year-old immunocompetent male presented with chronic headache, neck pain, and limited eye movement.
• Imaging revealed an isolated left sphenoid lesion with bone changes and an extradural abscess.
• Histological examination and fungal culture confirmed Scedosporium apiospermum CIFR.

Findings:

• Scedosporium apiospermum is an uncommon cause of CIFR.
• The patient exhibited an atypical presentation with isolated sphenoid infection, abducens nerve paralysis, and extradural abscess.
• Radiological findings mimicked fibrous dysplasia or bacterial osteomyelitis, deviating from typical CIFR imaging.

Implications:

• Surgical treatment alone may be sufficient for immunocompetent patients with S. apiospermum CIFR.
• This case expands the understanding of atypical presentations and imaging findings in CIFR.
• Highlights the importance of considering rare fungal pathogens in complex sinonasal infections.