Uncommon common cold: Intracranial fungal ball

Abstract

Aim: To present an unusual clinical opportunity with invasive fungal sinusitis. Background: Mucormycosis is a rare opportunistic zygomycotic fungal infection occuring mainly in immunocompromised patients. Rhinocerebral mucormycosis is the most common form of the disease. Case description: Here we present a rare case of intracranial mucormycosis in an immunocompetent patient. The patient presented with left nasal block and recurrent nasal discharge. Nasal endoscopy showed multiple pale polyps. Magnetic resonance imaging findings showed left frontal, ethmoidal, and sphenoid sinusitis with leptomeningeal enhancement. Management: A dual endonasal–transcranial approach was used by a neurosurgeon and ENT surgeon for the complete clearance of the disease. The histopathological examination was reported as mucormycosis, and the patient was started on inj liposomal amphotericin B. Patient was followed up postoperatively by serial nasal endoscopy and imaging as required. Conclusion: Mucormycosis in an immunocompetent patient with polyps and dural erosion is a rare entity and hence requires complete removal of the disease process and reconstruction of the dura followed by the inj liposomal Amphotericin B. The patient needs regular clinicradiological follow-up to detect recurrence. Clinical significance: Awareness of unusual manifestations and complications of paranasal sinus fungal disease is essential.