Persistent Severe Headache After Removal of Fungus Ball From the Sphenoid Sinus: A Case Report.

OBJECTIVE: Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity. METHODS: A chart review and review of the literature. RESULTS: We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole. CONCLUSIONS: GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis.

Silent threat of isolated sphenoid sinus tuberculosis resulting in blindness and ophthalmoplegia.

A diabetic woman in her fifties presented with a sudden onset of failing vision and diplopia involving the right eye for two days, along with fever and headache. Radiological investigations revealed right sphenoid sinusitis along with inflammation around the right orbital apex and optic nerve. Functional endoscopic sinus surgery, with orbital and optic nerve decompression improved the ocular movements, but not the visual acuity. Histopathology was suggestive of a granulomatous inflammatory lesion, and high-resolution computed tommography (HRCT) of the thorax revealed lung lesions suggestive of an old tubercular infection, and antitubercular treatment (ATT) was then initiated.At the end of two months of ATT, there was complete resolution of ophthalmoplegia, relative afferent pupillary defect, direct and consensual light reflex however, failure of improvement in her visual acuity, indicated damage to the optic nerve.Extrapulmonary tuberculosis involving an isolated sphenoid sinus is rare and elusive. Prompt radiological investigations, followed by orbital decompression and ATT, provide the best possible outcomes.

Aspergilose invasiva do seio esfenoidal e paralisia do 6§ nervo / Invasive aspergillosis of the sphenoid sinus and paralysis of the 6th nerve

A aspergilose do seio esfenoidal é doença rara e pode se apresentar sob diferentes formas clínicas devido a envolvimento de diversas estruturas anatomicamente adjacentes ao seio esfenoidal. Relatamos o caso de uma paciente com 74 anos de idade, diabética, com paralisia do sexto nervo esquerdo secundária a aspergilose do seio esfenoidal. Näo havia história de cefaléia ou de queixas sugestivas de alergia respiratória. A tomografia computadorizada revelou lesäo etmoideo-esfenoidal à esquerda, com presença de imagem cálcica em seu interior e destruiçäo óssea. A paciente foi submetida a cirurgia com retirada de material necrótico e debridamento da lesäo, seguida de tratamento com anfotericina B e 5-fluorocitosina. Exame histológico revelou a presença de hifas sugestivas de Aspergilus sp. Após três meses de tratamento a paciente apresentou recuperaçäo total da paresia do nervo abducente. O diagnóstico pré-operatório de aspergilose do seio esfenoidal é dificil. No entanto, a presença de imagem cálcica ou de densidade metálica à radiografia simples de crânio ou à tomografia computadorizada sugere fortemente o diagnóstico. O exame histológico revela a presença de hifas dicotomatosas em 45,0 típicas do Aspergillus. O tratamento inclui excisäo e debridamento da lesäo seguida do uso de anfotericina B associada a 5-fluorocitosina ou rifampicina