Infect Chemother.  2008 Apr;40(2):110-115. 10.3947/ic.2008.40.2.110.

Invasive Aspergillosis of the Paranasal Sinuses Invading Skull Base : Successful Treatment with Voriconazole

• Eun CR
• Heo JY
• Noh JY
• Youn YK
• Lee HJ
• Shin BK
• Lee J
• Song JY
• Cheong HJ
• Kim WJ

• KMID: 2230014
• DOI: http://doi.org/10.3947/ic.2008.40.2.110

Abstract

Skull base-invading, invasive aspergillosis is rare, but it is a potentially life-threatening disease. Nevertheless, the standard method and the optimal duration of treatment are not known yet. A 52-year-old female diabetic patient complained of ophthalmalgia and decreased visual acuity. MRI and CT scan revealed an enhancing mass in the right orbital fissure and showed an infiltrating process in the skull base around the right orbit apex and paranasal sinuses. The histological investigation revealed invasive aspergillosis of paranasal sinuses and the skull base. Clinical improvement occurred after marsupialization and post-operative systemic antifungal therapy with voriconazole for 14 weeks. We suggest that voriconazole treatment could show effective results for invasive aspergillosis of skull base and paranasal sinuses.

Keyword

Invasive aspergillosis; Skull base; Voriconazole

MeSH Terms

Aspergillosis
Female
Humans
Middle Aged
Orbit
Paranasal Sinuses
Pyrimidines
Skull
Skull Base
Triazoles
Visual Acuity
Pyrimidines
Triazoles

Figure

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  Fig. 1 Posterior Fossa MRI T1WI image shows an enhancing mass like lesion in the right skull base around the superior orbital fissure, anterior middle cranial fossa, around the lateral wall of the right sphenoid sinus, right orbital apex and around the right carvernous sinus: (A) before voriconazole treatment, (B) 4 weeks following voriconazole treatment, (C) at the time of discontinuation of treatment for 14 weeks, and (D) 9 months later from treatment completion.

• 

  Fig. 2 (A) Specimen from mass of right nasal cavity showing Aspergillosis in Gomori's methenamine-silver (GMS) stain, ×1,000, (B) Slide showing Aspergillus hyphae invading tissue in GMS stain, x1,000.

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