Management of Isolated sphenoidal aspergillosis: Case report and review of literature

INTRODUCTION AND IMPORTANCE: Sphenoidal aspergillosis is an uncommon serious condition that could lead to a fatal outcome. There is dilemma in its management. Published data concerning this pathology are limited so we find interesting in adding our experience to the literature mass. In fact, this work focused on the description of the clinical features of this entity as well as its management by presenting a case report and reviewing literature. CASE PRESENTATION: We report a case of 53 years old male who presented to the outpatient department of our university teaching Hospital with isolated chronic headache complaint that evolving through two years. His physical examination revealed no abnormalities. CT scan of facial bone and MRI showed an aspect in favor of sphenoidal aspergillosis. He underwent an endoscopic sphenoidotomy. Microscopic examination was consistent with the diagnosis of sphenoidal aspergillosis. There were no needs to associate an antifungal treatment since we estimate the surgery excision was complete. The patient remained free of disease after surgery for a follow-up of 4 years. CLINICAL DISCUSSION: Aspergillosis is ubiquitous in nature, currently causing severe disease in both immunocompetent and immunocompromised patients. Its frequency has increased over the past few years due to the widespread use of antibiotics, corticosteroids, and improved diagnostic methods. Surgery is the primary form of treatment, however if signs of invasion are present, it should be supplemented with an anti-fungal treatment. CONCLUSION: Sphenoidal aspergillosis is a rare condition whose diagnosis is not always obvious. The clinician should always bear this diagnosis in mind in patients with chronic sinusitis avoiding invasive and fulminant forms which could be life-threatening.