Sino Cranial Aspergillosis Mimicking Skull Base Meningioma- A Case Report and Review of Literature
Published: January 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/46498.14427
Vishwanath Joshi, Saumya Rao, Neemish Kamat, Mitusha Verma, Deepak Patkar
1. Fellow, Department of Radiodiagnosis, Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
2. Resident, Department of Radiodiagnosis, Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
3. Consultant, Department of Radiodiagnosis, Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
4. Consultant, Department of Radiodiagnosis, Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
5. Head of Imaging, Department of Radiodiagnosis, Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
Correspondence
Vishwanath Joshi,
SV Road, Vile Parle West, Mumbai, Maharashtra, India.
E-mail: vishuvjoshi@gmail.com
Fungal infections of the nose and paranasal sinuses can be categorised into invasive and noninvasive forms. Central Nervous System (CNS) Aspergillosis is extremely rare in immunocompetent individuals. Invasive fungal sinusitis affecting CNS commonly poses a diagnostic dilemma on imaging, often confused with neoplastic processes. Here, Authors report a case of invasive sino cranial aspergillosis in immunocompetent individual mimicking a meningioma on imaging. A 46-year-old male patient presented with history of seizure like episode and right eye proptosis to Neurology Department. On Magnetic Resonance Imaging (MRI), there was enhancing T2 weighted hypointense extra-axial mass lesion along right frontal convexity with associated osseous erosion, intraorbital extension and associated sinus disease. Based on clinical presentation and imaging features, initial diagnosis of a aggressive neoplastic lesion was made. Patient subsequently underwent biopsy which showed fungal elements of Aspergillus Fumigatus species. Patient underwent endoscopic sinus surgery and along intravenous and oral antifungal therapy with good response to treatment. This case highlights the key role of imaging including MRI and CT in making accurate diagnosis of fungal sinusitis especially in immunocompetent individuals and differentiate from other entities like meningioma.
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