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

Chai Ryoung Eun; Jung Yeon Heo; Ji Yun Noh; Young Kyung Youn; Hyun Joo Lee; Bong Kyung Shin; Jacob Lee; Joon Young Song; Hee Jin Cheong; Woo Joo Kim

doi:10.3947/ic.2008.40.2.110

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Eun, Heo, Noh, Youn, Lee, Shin, Lee, Song, Cheong, and Kim: Invasive Aspergillosis of the Paranasal Sinuses Invading Skull Base : Successful Treatment with Voriconazole

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2008; 40(2): 110-115.

Published online: 20 April 2008

DOI: https://doi.org/10.3947/ic.2008.40.2.110

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

Chai Ryoung Eun, M.D.¹, Jung Yeon Heo, M.D.¹, Ji Yun Noh, M.D.¹, Young Kyung Youn, M.D.¹, Hyun Joo Lee, M.D.², Bong Kyung Shin, M.D.², Jacob Lee, M.D.¹, Joon Young Song, M.D.¹, Hee Jin Cheong, M.D.¹, Woo Joo Kim, M.D.¹

¹Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

²Department of Pathology, Korea University College of Medicine, Seoul, Korea.

Correspondence : Hee Jin Cheong, M.D. Division of Infections Disease, Department of internal Medicine, Korea University College of Medicine, 37, Guro-gu, Seoul 152-703, Korea. Tel: 82-2-2626-3050, Fax: 82-2-837-1966, heejinmd@medimail.co.kr

Received 28 November 2007 Accepted 11 February 2008

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Invasive aspergillosis, Skull base, Voriconazole

Figures and Tables

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.

Table 1

Summary of Documented Cases of Invasive Aspergillosis Involving Paranasal Sinus and/or Skull Base: Cases of the Republic of Korea

Abbreviations : ampB, amphotericin B deoxycholate; liposomal ampB, liposomal amphotericin B; AML, acute myelogenous leukemia; CR, complete remission

Table 2

Summary of Documented Cases of Invasive Aspergillosis Involving Paranasal Sinus and/or Skull Base: Cases of Foreign Countries

Abbreviations : ampB, amphotericin B deoxylate; liposomal ampB, liposomal amphotericin B

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