Slowly progressive invasive rhino‐orbito‐cerebral aspergillosis: case report and literature review

Abstract

Key Clinical MessageThis is a report of a patient with aspergillosis infection, which was thought to be a tumoral lesion during its investigation. This is not a common disease in Western countries, and this report should increase our awareness for differential diagnosis of nasal masses. Early diagnosis is desired in order to increase the survival rates.

Invasive Aspergillus flavus sinusitis in an immunocompetent patient using intranasal cocaine

“…Invasive fungal sinusitis generally occurs in the setting of neutropenia, immunosuppressive drugs, diabetes, HIV, trauma, or radiation therapy [2] , [3] , [4] , [5] . Other associated factors include male gender [3] , [10] , [20] , [21] , asthma [11] , [12] , use of inhalational steroids [1] , [12] , marijuana use [12] , heavy smoking [3] , individuals in the 3rd or 4th decade of life [10] , [21] , alcoholism [13] , [22] , farming occupation [3] , [8] , [11] , [12] , trauma or a surgical procedure such as implantation of prosthetic material [16] , septal surgery [20] , and endemic locations such as the Middle East, Indian sub-continent, and Southern United States [7] , [8] , [9] likely due to hot, dry climates [10] .…”

“…The diagnosis of invasive fungal sinusitis is established with tissue histologic examination and fungal culture via tissue biopsy. It is important to note that surface cultures are often negative, and symptoms may precede radiological findings [8] , [13] , [16] , [17] . In one case series only 10 of 16 (63%) patients with invasive sinusitis from aspergillosis had a positive culture [21] .…”

“…This is illustrated in one case report where non-invasive disease converted to invasive disease in an elderly patient [29] . Longer duration of symptoms is associated with progression to intra-cranial disease and possible dural invasion, which carries a high risk of mortality [7] , [8] , [9] , [10] . Additionally, Aspergillus can occlude the vascular supply and inhibit anti-fungal treatment from reaching infected areas [22] .…”

“…Invasive fungal sinusitis is a dangerous form of infection by Aspergillus , with mortality rates as high as 80% [1] . Although invasive infection typically occurs in immunocompromised patients [2] , [3] , [4] , [5] , [6] , other risk factors include hot, dry climates [7] , [8] , [9] , [10] , farming occupations [3] , [8] , [11] , [12] , maxillary tooth extraction [2] , [11] , [12] , [13] , [14] , and intranasal cocaine use [5] , [15] . Diagnosis can be challenging as topical nasal cultures are often negative and symptoms often precede significant radiological findings [8] , [13] , [16] , [17] .…”

“…Although invasive infection typically occurs in immunocompromised patients [2] , [3] , [4] , [5] , [6] , other risk factors include hot, dry climates [7] , [8] , [9] , [10] , farming occupations [3] , [8] , [11] , [12] , maxillary tooth extraction [2] , [11] , [12] , [13] , [14] , and intranasal cocaine use [5] , [15] . Diagnosis can be challenging as topical nasal cultures are often negative and symptoms often precede significant radiological findings [8] , [13] , [16] , [17] . Invasive fungal sinusitis left untreated can lead to significant neurological symptoms and mortality rates ranging 28–80% [1] , [5] , [16] .…”