Sphenoid aspergillosis, an unusual suspect

Abstract

Isolated sphenoid sinus disease represents only 2-3% of the total sinus pathology, and when it is present, it usually has an inflammatory origin. It seldom affects an immunocompetent person, and it is very rare in children. Our goal is to draw attention to this pathology introducing our recent experience, and to draw conclusions in order to always bear in mind a wide spectrum of possible differential diagnoses. We present the clinical experience at our hospital with a rare pathology such as isolated sphenoidal aspergillosis, reviewing the patient‘s personal background, clinical features, diagnosis techniques, prognosis and optimal therapy. Our patient is a 73-year-old male with long-term intense headache located in the frontal and periocular regions. Initially, common analgesics were strong enough to relieve the pain, but eventually it became more and more intense, with no response to medication. In addition, he presented cervical pain, photophobia, sonophobia, weight loss, ocular tingling and blurred vision. There was no rhinorrea, fever, or any other infectious symptom. Initial sphenoid sinus pathology symptoms are not very precise, with a latent and chronic set up, and they are also hard to characterize. Up to 70% of patients show visual disturbances, which generally derive in immediate complications. Prognosis is worse than in other location because of early intracranial dissemination. Thus, sphenoid aspergillosis can be considered as being a potentially lethal disease in immunodeficient patients, but nowadays, fungal behavior is changing. This was the case here, as the patient remained immunocompetent.