Rhino-Cerebral Aspergillosis in an Immunocompetent Patient

Abstract

Rhino-cerebral aspergillosis is a rare phenomenon describing a contiguous spread of Aspergillus species from the paranasal sinuses to the intracranial space. In this case report, we describe a case of invasive rhino-cerebral aspergillosis arising in the setting of prolonged intranasal steroid use in an 81-year-old patient with chronic sinusitis. This case report emphasizes the importance of recognizing steroid use as a risk factor for invasive aspergillosis in otherwise immunocompetent individuals.

Keywords: Aspergillus; Chronic sinusitis; Intranasal steroid; Invasive aspergillosis; Rhino-cerebral aspergillosis.

Fig. 1

Sinus CT without contrast showed moderate left maxillary sinusitis with narrowing of the left osteomeatal unit with mucosal disease.

Fig. 2

MRI orbit with and without contrast showing aggressive sinus inflammatory process with evidence of bone destruction through the left pterygopalatine fossa.

Fig. 3

MRI brain with contrast demonstrating peripheral enhancing collection in left anteromedial temporal lobe measuring 11 x 8 × 11 mm appearing more organized and well-defined. Although not seen in this view, an additional peripherally enhancing lesion measuring 4 × 7 x 6 mm was visualized along the posterior lateral margin of the collection.