Invasive Fungal Rhinosinusitis With Intracranial and Orbital Involvement: A Case Report

Invasive fungal rhinosinusitis can be fatal if it spreads from the orbit to the cranium. The primary treatment involves thorough lesion debridement; however, complete removal may be challenging in cases involving intracranial extension. Here, we report a case of invasive fungal rhinosinusitis with intracranial and orbital invasion successfully managed with maximal surgical debridement and antifungal therapy. The patient was a 59-year-old man with untreated diabetes mellitus who had experienced a gradual decrease in right-eye vision over the past month. He sought medical attention at a local hospital and was referred to our hospital for further examination. Computed tomography and magnetic resonance imaging scans revealed a soft tissue mass with accompanying bone destruction extending to the tip of the right orbit. Inflammation had spread to the dura mater, and cavernous sinus invasion was also observed. A biopsy was performed under endoscopy, and invasive fungal rhinosinusitis due to Aspergillus was diagnosed. We started treatment with the antifungal agent voriconazole (VRCZ), and 12 days after the biopsy, we performed endoscopic sinus surgery for debridement, removing as much of the lesion as possible. We decided to continue conservative treatment with VRCZ for the residual lesion. Two years postoperatively, the fungal lesion has maintained a reduced size. In this case, complete removal of the lesion was challenging; however, the present case suggests that disease control is possible by removing as much of the lesion as possible and administering VRCZ.