Abstract
Invasive fungal paranasal mycosis can destroy the bone and invade the orbital or endocranial cavities. Therefore, it is necessary for this condition should be diagnosed early and treated promptly. We encountered a case of acute invasive paranasal aspergillosis which unfortunately was not diagnosed early and could not be treated promptly.
The patient was an 85-year-old woman who was diabetic. She presented to the ER of this hospital with the chief complaint of headache. There were no abnormal findings and a diagnosis could not be made at the first clinical examination. Subsequently, she was admitted to the endocrinology ward of the hospital with a history of pain, trouble moving and visual loss in her right eye. She was referred to our department because of the observation on CT and contrast-enhanced MRI images of an invasive opacity in the orbital apex and cavernosus sinus as it branched off from the sphenoidal sinus. Therefore, we performed endonasal endoscopic biopsy to confirm the diagnosis. The biopsy revealed an edematous mucous membrane and the presence of mycetes, and the diagnosis of invasive paranasal aspergillosis was made. The fungal infection was difficult to control and the patient died on day 21 after the endoscopic procedure despite treatment with antifungal drugs.
Our case highlights the importance of prompt biopsy for early diagnosis and immediate treatment in patients complaining of headache and eye symptoms who are suspected to have invasive paranasal mycosis.
