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Skull base osteitis following fungal sinusitis

Published online by Cambridge University Press:  29 June 2007

Andrew C. Swift  and
David W. Denning
Andrew C. Swift*
Affiliation:
Department of Otolaryngology, Aintree Hospitals Trust – Walton, Liverpool and the Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK.
David W. Denning
Affiliation:
Department of Otolaryngology, Aintree Hospitals Trust – Walton, Liverpool and the Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK.
*
Address for correspondence: Mr A. C. Swift, Consultant Otorhinolaryngologist, Aintree Hospital Trust – Walton, Rice Lane, LiverpoolL9 1AE. Fax: 0151 529 4033
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Abstract

Aspergillus sp. sinusitis is not uncommon in immunocompromised patients but is unusual in patients who are not immunocompromised. The disease may occur as a saprophytic condition, as an allergic sinusitis or as a potentially lethal invasive disease. The differentiation between non-invasive and invasive Aspergillus sp. sinusitis is crucial and this distinction is fully discussed. The treatment options are also considered. Invasive disease requires aggressive treatment with long-term antifungal agents in sufficient doses combined with wide surgical excision.

We present a patient who presented with invasive Aspergillus fumigatus sinusitis and subsequently developed cranial neuropathies and skull base osteitis. She was initially treated with oral itraconazole (400 mg daily) for 18 months but due to lack of response this was changed to a new experimental oral azole (voriconazole) which was continued for a further 14 months. She has since remained well for the last five years.

Keywords

Fungal sinusitisAspergillus
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 112 , Issue 1 , January 1998 , pp. 92 - 97
Copyright
Copyright © JLO (1984) Limited 1998

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References

Brown, P., Demaeral, P., McNaught, A., Revesz, T., Graham, E., Kendall, B. E., Plant, G. (1994) Neuro-ophthalmological presentation of non-invsive aspergillus sinus disease in the non-immunocompromised host. Journal of Neurology, Neurosurgery and Psychiatry 57: 234–237.Google Scholar
Chang, T., Teng, M. M. H., Wang, S. F., Li, W. Y., Cheng, C. C., Lirng, J. F. (1992) Aspergillosis of the paranasal sinuses. Neuroradiology 34: 520–523.Google Scholar
Corey, J. P., Romberger, C. F., Shaw, G. Y. (1990) Fungal diseases of the sinuses. Orolaryngology – Head and Neck Surgery 103: 1012–1015.Google Scholar
de Carpentier, J. P., Ramamurthy, L., Denning, D. W., Taylor, P. H. (1994) An algorithmic approach to aspergillus sinusitis. Journal of Laryngology and Otology 108: 314–318.Google Scholar
Demaeral, P., Brown, P., Kendall, B. E., Revesz, T., Plant, G. (1993) Case report: allergic aspergillosis of the sphenoid sinus: pitfall on MRI. British Journal of Radiology 66: 260–263.CrossRefGoogle Scholar
Denning, D. W., Lee, J. Y., Hostetler, J. S., Pappas, P., Kauffman, C. A., Dewsnup, D. H., Galgiani, J. N., Graybill, J. R., Sugar, A., Catanzaro, A., Gallis, H., Perfect, J. R., Dockery, B., Dismukes, W. E., Stevens, D. A. (1994) NIAID mycoses study group multicenter trial of oral itraconazole therapy for invasive aspergillosis. American Journal of Medicine 97: 135–144.Google Scholar
Denning, D. W. (1996) Therapeutic outcome in invasive aspergillosis. Clinical Infectious Diseases 23: 608–615.Google Scholar
Denning, D. W. (1997) Aspergillus, aspergilloma and invasive aspergillosis. In Principles of Medical Mycology, 1st Edition (Mitchell, T. G., Cutler, J. E., Deepe, G. S., Hazen, K. C., eds.). American Society for Microbiology, Washington DC.Google Scholar
Dunlop, I. S., Billson, F. A. (1988) Visual failure in allergic aspergillus sinusitis: case report. British Journal of Ophthalmology 72: 127–130.CrossRefGoogle Scholar
Ericcson, M., Anniko, M., Gustafsson, H., Hjalt, C.-A., Stenling, R., Tarnvik, A. (1993) A case of chronic progressive rhinocerebral mucormycosis treated with liposomal amphotericin B and surgery. Clinical Infectious Diseases 16: 585–586.Google Scholar
Farrior, J. (1989) Osteomyelitis of the skull base. Southern Medical Journal 82: 719–722.Google Scholar
Ishida, M., Taya, N., Noira, T., Kamihata, T., Hatta, C., Matsomoto, T., Sugiyama, Y., Yoshihara, W. (1993) Five cases of mucormycosis in paranasal sinuses. Acta Otolaryngologica (Stockholm) Suppl 501: 92–96.Google Scholar
Law, D., Moore, C. B., Denning, D. W. (1994) Bioassay for serum itraconazole concentrations using hydroxitraconazole standards. Antimicrobial Agents and Chemotherapy 38: 1561–1566.Google Scholar
McGill, T., Simpson, G., Healy, G. B. (1980) Fulminant aspergillosis of the nose and paranasal sinuses: a new clinical entity. Laryngoscope 90: 748–754.CrossRefGoogle Scholar
Morrison, V. A., McGlave, P. B. (1993) Mucormycosis in the BMT population. Bone Marrow Transplantation 11: 383–388.Google Scholar
Rowe-Jones, J. M., Moore-Gillon, V. (1994) Destructive noninvasive paranasal sinus asperigillosis: component of a spectrum of disease. Journal of Otolaryngology 23: 92–96.Google Scholar
Stammberger, H. (1991) Mycoses. In Functional Endoscopic Sinus Surgery (Hawke, M., ed.). Decker, BC, Philadelphia, p 399.Google Scholar
Tsimikas, S., Hollingsworth, H. M., Nash, O. (1994) Aspergillus brain abscess complicating allergic aspergillus sinusitis. Journal of Allergy and Clinical Immunology 94: 264–267.Google Scholar
Tsuboi, K., Higuchi, O., Nose, T., Maki, Y. (1988) Intracranial aspergillus granuloma originating in the sphenoid sinus. Neurologia Medico-Chirurgica (Tokyo) 28: 1014–1019.Google Scholar
Veress, B., Malik, O. A., El Tayeb, A. A., El Daoud, S., El Mahgoub, S., El Hassan, A. M. (1973) Further observations on the primary paranasal aspergillus granuloma in the Sudan. American Journal of Tropical Medicine and Hygiene 22: 765–772.Google Scholar
Washburn, R. G., Kennedy, D. W., Begley, M. G., Henderson, D. K., Bennett, J. E. (1988) Chronic fungal sinusitis in apparently normal hosts. Medicine 67: 231–247.Google Scholar
Waxman, J. E., Spector, J. G., Sale, S. R., Katzenstein, A. A. (1987) Allergic aspergillus sinusitis: concepts in diagnosis and treatment of a new clinical entity. Laryngoscope 97: 261–266.Google Scholar
Weisberger, E. C., Dedo, H. H. (1977) Cranial neuropathies in sinus disease. Laryngoscope 87: 357–363.Google Scholar
Wilson, M., Denning, D. W. (1993) The commonest life-threatening mould infection: invasive aspergillus. Hospital Update April: 225–233.Google Scholar