Chronic invasive fungal sinusitis

Case contributed by Dr Ahmed Abdrabou

Presentation

Recurrent attacks of sinusitis. Now the patient came with a persistent headache and diplopia.

Patient Data

Age: 25 years
Gender: Male

Opacification of the left maxillary, left frontal, left ethmoid, right posterior ethmoidal and sphenoidal sinuses bilaterally with mucosal reaction with hyperdense material inside. Moreover, there is partial destruction of the clivus, as well as the left medial orbital wall and left aspect of the cribriform plate. 

Left proptosis is also noted. 

Redemonstration of the sinus affection with the hyperdense material inside the sinuses exhibits iso to low intense signal on T1 and low signal on T2 WI. There is extensive mucosal enhancement post IV contrast administration. In addition, there is intracranial extraparenchymal extension through the cribriform plate and clivus as well as left intraorbital extraconal extension. 

The ICAs bilaterally and basilar arteries are spared as well as the optic chiasm. The pituitary gland is elevated due to the expansion of the sphenoid sinus. 

Case Discussion

Left-sided chronic sinusitis was complicated with an extensive fungal infection which caused bony destruction and intraorbital as well as intracranial invasion. The patient underwent surgical intervention and histopathology revealed chronic non granulomatous invasive fungal sinusitis. The responsible organism was Aspergillus flavus

The characteristic low T2 signal intensity of fungal sinusitis is owing to metallic particles in fungal hyphae.

Invasive fungal sinusitis usually affects immunocompromised patients. However, this patient came from middle eastern country where high humidity weather predisposes to fungal infection.  

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Case information

rID: 65691
Published: 22nd Jan 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Ain Shams University

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