Invasive Aspergillus rhinosinusitis complicated with cerebral abscess

摘要

A 66-year-old woman with poorly controlled insulin-dependent diabetes mellitus and rheumatoid arthritis and was on 10-mg oral methotrexate once-weekly had intermittent rhinorrhea–associated swelling in the right eye and cheek for four days. The symptoms started one week ago after thorough house cleaning. Computed tomography (CT) of the paranasal sinuses and orbits showed mucosal thickening of the bilateral frontal, ethmoid, sphenoid, and maxillary sinuses, suggesting sinusitis. Nasal endoscopy revealed right septal wall perforations and a fungal mass in the right maxillary cavity (Figure 1). Histopathological examination of the biopsied inferior turbinate revealed broad septate fungal hyphae (Figure 2); pan-fungal polymerase chain reaction showed Aspergillus fumigatus. Therefore, oral voriconazole was administered. She had decreased consciousness after three-week antifungal therapy. Urgent contrast-enhanced CT brain showed left frontal lobe abscess measuring 4.1×1.8×3.2 cm with a slight midline shift (Figure 3). However, her family refused neurosurgical intervention. Her condition deteriorated further and died one month later.