Basilar occlusion and rupture secondary to rare fungal sinusitis: A case report.

Basilar occlusion and rupture secondary to rare fungal sinusitis: A case report.

World Neurosurg. 2019 Feb 14;:

Authors: Monteiro A, Agnoletto GJ, Granja MF, Bit-Ivan EN, Sauvageau E

Abstract
BACKGROUND: Intracranial vascular infections of fungal etiology are extremely rare. The vast majority of cases occur in immunocompromised patients with invasive fungal disease, most commonly originating in the paranasal sinuses or the lungs. An extremely rare type in this part of the world, called Granulomatous Invasive Rhinosinusitis, has been reported to affect immunocompetent patients in most cases, and its causative strain has potential to invade the intracranial arteries.
CASE DESCRIPTION: We present a rare case of basilar artery rupture and infarction secondary to granulomatous invasive rhinosinusitis in a 50 year old male who presented with ischemic symptoms and 6 month history of headache, dizziness and falls in Florida, USA. After biopsy, the patient developed subarachnoid hemorrhage and thrombosis. Several thrombectomy attempts were performed, resulting in persistent occlusion of the basilar artery and subsequent comatous state. After discussion with the patient's family, the decision of compassionate wean and autopsy authorization was made.
CONCLUSIONS: Invasive fungal rhinosinusitis are more frequent nowadays due to increased use of immunosuppressive therapies. However, it is still a disease of immunocompromised. The development of new microbiology investigation techniques allowed for the discovery of fungal diseases that can also affect immunocompetent hosts, as in granulomatous invasive rhinosinusitis. This is an extremely rare condition is this part of the world, with very few cases in the last few decades.w.

PMID: 30772526 [PubMed - as supplied by publisher]

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