Non-invasive fungal sinusitis resulting in multiple cranial nerve neuropathies

Abstract

A 33-year-old man presented to the emergency department with a right-sided facial paralysis and maxillary division (V2, trigeminal nerve) paraesthesia. He had been suffering with upper respiratory tract symptoms in the preceding 2 months, including rhinorrhoea, fever and headache. The patient was otherwise fit and immunocompetent. Urgent radiological investigation revealed extensive fungal sinusitis with sphenoid sinus dehiscence and skull base osteitis. The patient underwent emergency endoscopic sinus surgery revealing concretions and debris in the ethmoid and sphenoid sinuses. He was commenced on systemic antifungal therapy and made a full recovery with resolution of his cranial neuropathies. The fungus Schizophyllum commune was isolated and is a rare cause of fungal sinusitis, but with the potential for invasive disease in immunosuppressed individuals.

Intermediate Invasive Fungal Sinusitis, a Distinct Entity From Acute Fulminant and Chronic Invasive Fungal Sinusitis

“…13 Numerous studies have suggested that non-invasive fungal forms can cause chronic erosive disease without displaying evidence of tissue invasion. [13][14][15][16] Recently, the transformation of non-invasive to invasive forms of fungal sinusitis has been reported. [17][18][19] Ma et al 19 demonstrated in a case series that 5 patients with allergic fungal sinusitis converted to cIFS, and 2 converted to aIFS.…”