Invasive fungal sinusitis with abducens nerve palsy

Though rare, sphenoid sinusitis can cause abducens nerve palsy because of the anatomical proximity of the sphenoid sinus and the abducens nerve.

A male patient in his late seventies presented with double vision and left abducens nerve palsy. Imaging revealed sinus opacifications later identified as due to Scedosporium apiospermum, a rare fungal pathogen. Despite being immunocompetent, the patient developed invasive fungal sinusitis involving the sphenoid sinus. Treatment included systemic antifungal therapy with voriconazole and sinus surgery. Follow-up imaging showed sinus recovery and bony healing. Clinical improvement was noted, with resolution of abducens nerve palsy at the four-month follow-up.

This case highlights the importance of assessing relevant imaging findings outside the central nervous system on routine brain imaging, as well as the role of effective antifungal therapy and surgical management in rare cases of invasive fungal infection in immunocompetent patients. Prompt intervention can significantly improve outcomes.