A Case of Acute Invasive Sinus Fungal Infection Leading to Internal Carotid Artery Invasion for which Appropriate Surgical Therapy was Selected

Abstract

Sinus fungal infections are classified into four categories: acute invasive, chronic invasive, chronic non-invasive, and allergic fungal rhinosinusitis (AFRS). Acute invasive sinonasal rhinosinusitis is associated with various symptoms, such as visual impairment and cerebrovascular disease, and has a very poor prognosis (50%). We herein report a case of sinus fungal infection leading to internal carotid artery involvement and cerebral infarction along with a review of the literature. The patient was a 78-year-old male. His chief complaint was pain in the back of his left eye, of which he had been aware for two weeks prior to visiting our hospital. While he had been monitoring his progress, his symptoms showed little improvement, so he came to see us. He had a history of drug-induced pneumonia and was administered methylprednisolone. Based on the findings of computed tomography of the sinuses and head contrast magnetic resonance imaging, a diagnosis of fungal sinusitis was made, and the patient was scheduled for surgery on the same day. During hospitalization, the patient developed internal carotid artery involvement and cerebral infarction due to an acute invasive sinus-type fungal infection and underwent bypass surgery. This patient was in the high-risk group in terms of long-term steroid use and immunodeficiency due to malignancy, so it is important to always consider intraorbital and intracranial complications.