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Case report
Invasive aspergillosis of the skull base in an immunocompetent patient: a diagnostic challenge
  1. Alexandra Borges1,
  2. Lìgia Ferreira2,
  3. Ricardo Pacheco2 and
  4. Isabel Fonseca3
  1. 1Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  2. 2Department of Otolaryngology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  3. 3Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  1. Correspondence to Dr Alexandra Borges; borgalexandra{at}gmail.com

Abstract

We describe the case of a 32-year-old man from Cape Verde having headache and increasing visual loss. Clinical and radiological investigations disclosed a massive destructive lesion involving the anterior and central skull base, orbit and nasoethmoid region initially interpreted as a malignant small round cell tumour. Surgical biopsies were negative for neoplasm, showing an intense inflammatory infiltrate together with fungus, later characterised as Aspergillus flavus spp. The patient was immunocompetent with no evidence of congenital or acquired immunodeficiencies. Invasive fungal infections in immunocompetent patients are rare and can be a diagnostic challenge. The best diagnostic clues include the patient’s origin from tropical climates, imaging features and the identification of fungal hyphae on pathology specimens. Although a devastating disease in immunocompromised patients, craniocerebral aspergillosis in immunocompetent patients carries a better prognosis. Available literature supports the combined used of ‘conservative’ surgical resection and antifungal therapy as the best treatment option.

  • ear
  • nose and throat/otolaryngology
  • tropical medicine (infectious disease)
  • neuroimaging
  • radiology
  • head and neck surgery

https://doi.org/10.1136/bcr-2021-245517

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    Footnotes

    • Contributors AB: conceptualisation, data curation, writing of the original draft, reviewing and editing. LF: responsible for the clinical and surgical management and follow-up of the patient, provided the clinical and surgical information, critically reviewed the manuscript. RP: clinical and surgical management, manuscript review. IF: responsible for the pathological diagnosis, reviewed and provided the pathology slices, and critically reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.