A Case of Invasive Aspergillosis of Skull Base in a Diabetic Patient.
- Author:
Ji Yeon LEE
1
;
Sung Bum KIM
;
Yong Hyun KIM
;
Jeong Han KIM
;
Sang Kyun YU
;
Hee Young KIM
;
Young Kul JUNG
;
Seung Chul PARK
;
Hak Hyun JUNG
;
Jae Geol CHOI
;
Jin Soo LEE
;
Min Ja KIM
Author Information
1. Department of Internal Medicine, Korea University Medical College, Korea. macropha@chollian.net
- Publication Type:Case Report
- Keywords:
Aspergillosis;
Skull base;
Amphotericin B;
Gallium scan
- MeSH:
Amphotericin B;
Aspergillosis*;
Aspergillus;
Brain;
Debridement;
Diabetes Mellitus;
Earache;
Female;
Gallium;
Headache;
Humans;
Hyphae;
Immunocompromised Host;
Itraconazole;
Magnetic Resonance Imaging;
Mastoid;
Middle Aged;
Sinusitis;
Skull Base*;
Skull*;
Tympanoplasty
- From:
Infection and Chemotherapy
2003;35(5):310-314
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Invasive aspergillosis of skull base is a rare but potentially lethal disease which complicates fungal sinusitis and requires surgical debridement, and long term antifungal therapy. However, optimal duration of antifungal therapy and standard method to monitor of clinical response are not known. A 55-year-old diabetic female patient presented with headache and otalgia 4 months after surgery for non-invasive aspergilloma of sinus. Brain MRI findings revealed bone destructions at the skull base and mastoid process. Mastoidectomy and tympanoplasty were performed, and the resected specimen showed fungal hyphae invading the tissue. Amphotericin B was given for 9 weeks (a total dose of 3.3 g) with oral itraconazole, followed by itraconazole (400 mg daily) alone for another 12 weeks. Serial gallium scans, taken before treatment and at 8th and 16th weeks following therapy, showed gradual reduction in uptake of the lesions. We emphasize that non-invasive Aspergillus sinusitis may progress to invasive disease, and strong suspicion of invasiveness is mandatory, especially in immunocompromised patients including diabetes mellitus. Also, we suggest that gallium scan is useful for determining the presence and extent of the disease, and monitoring clinical response following therapy.
