2019 Volume 36 Issue 2 Pages 96-99
A 71–year–old man, who was taking azathioprine (50mg/day) because of ulcerative colitis, was admitted to the hospital because of sudden onset of dysarthria followed by pharyngeal discomfort on August 4. Neurological examination revealed atrophy of the tongue and deviation of the tongue to the left, suggesting the left hypoglossal nerve palsy. Gadolinium–enhanced 3D T1–weighted magnetic resonance imaging showed a mass lesion at the left hypoglossal canal. Computerized tomography showed an abscess with calcification extending to the parapharyngeal space from the tonsils. Serum levels of β–D glucan were slightly elevated (7.5pg/dL), and the test result for serum Aspergillus antigen was positive. Clinical characteristics and imaging features improved after antifungal treatment with liposomal amphotericin B. The patient was finally diagnosed as having invasive aspergillosis, which might invade into the hypoglossal canal from the tonsils through the pharyngeal space. Therefore, careful investigations of the parapharyngeal space and nasal sinuses are recommended when a fungal infection in the skull base is strongly suspected.
