Invasive Fungal Sinusitis of the Sphenoid Sinus: A Case Report and Literature Review

Abstract

We report a case of invasive aspergillosis which spread from the sphenoid sinus to the pterygopalatine fossa and orbital cavity. A 78-year-old man with diabetes and angina pectoris was admitted to the Cardiovascular Department of Shiga University of Medical Science Hospital for a cardiac catheter test. Because the patient had left temporal pain a month prior to admission, he underwent computed tomography (CT). There was an abnormal shadow on his bilateral sphenoid sinus and a bone defect of the left medial orbital wall. After visiting our department, he started to receive treatment for sphenoid sinusitis with Voriconazole (VRCZ) and Meropenem (MEPM). However, he had no light perception in his left eye, so we performed endoscopic sinus surgery (ESS) on day five. We found a fungus ball in his left sphenoid sinus and a bone defect of the left medial orbital wall. We made a diagnosis of invasive aspergillosis based on the pathological findings of Aspergillus. Although he received intensive antifungal drug therapy, ESS twice, and left orbital exenteration, he died about five months after admission.

There were sixty-nine cases of invasive sphenoid fungal sinusitis from 1988 to 2012 in Japan. Including our case, we analyzed seventy cases. The mortality was 45.7%, but was 22.7% in cases where VRCZ was administered. The most frequent organism was Aspergillus. The average period from symptom awareness to definite diagnosis was 4.2 months. However, the average was 7 months in cases where the patient died. The diagnosis of invasive fungal sinusitis of the sphenoid sinus is very difficult because of poor nasal symptoms and varied imaging findings. Furthermore, the sphenoid sinus is located near the optic canal, orbital cavity, cavernous sinus, and brain, so invasive fungal sinusitis can easily lead to severe complications, such as invasion of surrounding tissue, and frequently results in a lethal outcome. If there is a localized shadow on the sphenoid sinus, the possibility of invasive fungal sinusitis should be considered.