Non-surgical management of chronic granulomatous invasive fungal sinusitis with intracranial extension a case report and literature review


  • Nicholas G. Candy Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
  • Anushia Ashokan Department of Infectious Diseases, Royal Adelaide Hospital, South Australia, Australia
  • Wan Yin Lim South Australian Medical Imaging, Royal Adelaide Hospital, South Australia, Australia
  • Sarah E. Kidd National Mycology Reference Centre, Microbiology and Infectious Diseases, SA Pathology, South Australia, Australia
  • Craig James Department of Anatomical Pathology, Clinpath Pathology, South Australia, Australia
  • Amal Abou-Hamden Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
  • Alkis J. Psaltis Department of Otolaryngology and Head and Neck Surgery, Royal Adelaide Hospital, South Australia, Australia



Endoscopic surgery, Fungal sinusitis, Chronic sinusitis, Skull base surgery


Chronic granulomatous invasive fungal sinusitis (CGIFS) is a rare manifestation of the heterogeneous disease process of fungal rhinosinusitis that is traditionally managed with some form of resective or debulking surgery. Historically, these were invasive transfacial resections. With the development of endoscopic surgery this treatment has become less invasive, but surgery still forms a major component of management. It is a rare disease that usually only occurs in dry subtropical areas. We describe the case of a female in her 30’s who presented with progressive headache and facial paresthesia. Workup demonstrated a large destructive lesion centred on the left sphenoid sinus invading the orbit and middle cranial fossa. The patient underwent urgent biopsies with a presumed diagnosis of an invasive malignancy. Upon identifying fungal organisms on culture the patient was commenced on anti-fungal treatment. We describe the first medically managed case of CGIFS with orbital and intracranial extension and perform a review of the contemporary literature to better understand this rare and challenging condition.


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Case Reports