Abstract
Sphenoid aspergillosis is a rare sinonasal disease. We report a case of sphenoid sinus aspergillosis related to an internal carotid artery aneurysm. A 78-year-old man seen for headache and diplopia had symptoms including disorientation and diminished consciousness. Computed tomography (CT) showed a heterogeneously enhanced lesion within the sphenoid sinus, suggesting a malignant tumor or mycotic sinus infection. Endoscopic sphenoidectomy conducted to confirm the diagnosis showed the sphenoid sinus to be occupied by a pulsating mass that was not resectable due to massive arterial bleeding during the procedure. Magnetic resonance imaging (MRI) and angiography involving the carotid artery showed an internal carotid artery aneurysm. Conservative therapy with antibiotics, steroids, and antifungal agents was continued, but the patient died on postoperative day 13th. Postmortem examination showed a large fungal mass in the sphenoid sinus. Invasive sphenoid sinus aspergillosis has a dismal prognosis rendering early diagnosis and therapy extremely important for treatment, particularly in immunocompromised patient.
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