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Skull base osteitis following fungal sinusitis

A C Swift¹, D W Denning

¹Department of Otolaryngology, Aintree Hospitals Trust, Walton, Liverpool.

The Journal of Laryngology and Otology

|April 16, 1998

Summary

Invasive Aspergillus sinusitis is rare in non-immunocompromised individuals. This case study highlights successful treatment of invasive Aspergillus fumigatus sinusitis with voriconazole after itraconazole failure.

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Area of Science:

Otolaryngology
Infectious Diseases
Mycology

Background:

Aspergillus sinusitis can manifest as saprophytic, allergic, or invasive disease.
Invasive forms are rare in non-immunocompromised patients and can be life-threatening.
Differentiating non-invasive from invasive Aspergillus sinusitis is critical for appropriate management.

Observation:

A non-immunocompromised patient presented with invasive Aspergillus fumigatus sinusitis.
The patient developed complications including cranial neuropathies and skull base osteitis.
Initial treatment with oral itraconazole (400 mg daily for 18 months) was ineffective.

Findings:

Treatment was switched to voriconazole, an experimental oral azole, for 14 months.
The patient achieved remission and remained well for five years post-treatment.
This case underscores the potential for aggressive invasive Aspergillus sinusitis in non-immunocompromised individuals.

Implications:

Aggressive treatment, including antifungals and surgery, is necessary for invasive Aspergillus sinusitis.
Voriconazole represents a viable therapeutic option for refractory invasive Aspergillus sinusitis.
Further research into invasive Aspergillus sinusitis in non-immunocompromised populations is warranted.

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