A Case of Invasive Paranasal-Skull Base Mycosis

Abstract

Paranasal mycosis is divided into non-invasive and invasive types. The invasive type is rare, but sometimes fatal; it can extend up to the skull base and affect the orbital cavity with bone destruction. We encountered a case of invasive paranasal-skull base mycosis resistant to surgical and pharmacological treatments. A 78-year-old man developed persistent headache and retro-ocular pain in June, 2004, and consulted the Department of Neurosurgery and Otorhinolaryngology, Ritsurin Hospital on July 20. CT scan demonstrated a soft tissue shadow in the ethmoid and sphenoid sinus with bone destruction of the skull base. We performed endonasal endoscopic biopsy on July 30, but we could not open the sphenoid sinus because of bleeding. Therefore, we only opened the bilateral ethmoid sinuses. The result of biopsy showed granulation tissue. On August 11, endonasal endoscopic surgery was performed to obtain biopsy and culture as well as to drain the sphenoid sinus. The second histopathological examination demonstrated a fungus ball. Culture of this fungus ball demonstrated Aspergillus fumigatus. Post-operative CT scan showed the persistent residue of a soft tissue shadow and expansion of a bone defect of the skull base. The patient was referred to Kagawa University for further treatment. Endonasal endoscopic surgery was performed again to remove residual fungus on August 20. Antifungal drug therapies had been administered throughout the treatment period, but we failed to control the fungal disease. The patient died on September 21.