Allergic fungal rhinosinusitis leading to catastrophic multiple ischemic strokes: a case report

Abstract

Allergic fungal rhinosinusitis (AFRS) is a non-invasive subtype of chronic rhinosinusitis. Although bone erosion and cerebrovascular involvement are rare, they may lead to severe complications. Standard management includes endoscopic sinus surgery and perioperative systemic corticosteroids. We describe a case of a 38-year-old immunocompetent man presenting with a 3-month history of nasal obstruction and progressive frontotemporal headache without fever or neurological deficits. Imaging revealed a large expansile sphenoid lesion with bone erosion and parasellar extension. Despite surgery and broad medical therapy, he developed multifocal ischemic events. Histopathology confirmed AFRS, and Aspergillus fumigatus was isolated; other microorganisms were excluded. His condition deteriorated, and he died 37 days after presentation. This case illustrates the rare but life-threatening potential of AFRS, particularly with sphenoid involvement. Although limited by its single-case design, it highlights the need for early recognition and intervention, as progression to fulminant forms may occur.