A case of invasive sinus mycosis identified with occipital pain and atypical trigeminal neuralgia

Abstract

We report a case of a 73-year-old man with intractable headache and facial pain, who was found to have an invasive sinus fungus infection on computed tomography. He underwent endoscopic intranasal surgery and was subsequently treated with antifungal drugs, but he had constant severe headaches. We treated him mainly with NSAIDs, acetaminophen, and pregabalin, but the effect became limited as the disease progressed. Finally, fentanyl patch was used to relieve the pain. Among sinusitis, sphenoidal sinus lesions tend to cause visual disturbance and headache with few nasal symptoms, which often leads to delay in diagnosis. Early diagnosis is often difficult and may lead to delay in antimicrobial therapy and worsening of the lesions by steroid administration. Periodic imaging evaluation is important for long-term persistent headache and facial pain.