Invasive Aspergillus Sinusitis Masquerading as Hypertrophic Pachymeningitis Complicated by a Ruptured Infectious...

Area of Science:

• Neurology
• Infectious Diseases
• Ophthalmology

Background:

• A 76-year-old man presented with neurological deficits suggestive of cranial neuropathy and visual loss.
• Initial diagnostic workup suggested hypertrophic pachymeningitis, a rare inflammatory condition affecting the dura mater.

Purpose of the Study:

• To highlight the diagnostic challenges posed by invasive fungal sinusitis.
• To underscore the risks associated with empirical corticosteroid therapy in suspected inflammatory diseases.
• To emphasize the importance of multidisciplinary management in complex cases.

Main Methods:

• Case report of a patient with progressive visual loss and neurological symptoms.
• Review of diagnostic imaging (MRI) and cerebrospinal fluid analysis.
• Evaluation of treatment response to corticosteroids and subsequent surgical and endovascular interventions.

Main Results:

• Initial misdiagnosis as hypertrophic pachymeningitis led to transient improvement with corticosteroids.
• Re-evaluation revealed invasive Aspergillus sinusitis with sphenoid sinus destruction.
• Complications included a ruptured internal carotid artery aneurysm requiring endovascular embolization.
• The patient survived a subarachnoid hemorrhage following multidisciplinary intensive care.

Conclusions:

• Invasive fungal sinusitis can present insidiously, mimicking other neurological and inflammatory conditions.
• Empirical corticosteroid use without excluding fungal infection can be detrimental.
• Early and accurate diagnosis, alongside aggressive, multidisciplinary treatment, is vital for patient survival.