Allergical fungal sinusitis with intracranial abscess--a case report and literature review.

Fungus infection of the sinunasal tract usually follows a slow, nonaggressive course. With massive bone destruction or along the foramen of skullbase, the disease may extend outside the confines of the sinunasal tract even into intracranum, causing cerebral epidural, subdural and intracerebral abscess. Recently, allergic fungal sinusitis (AFS) has been a described disease entity, usually occurring in immunocomponent individuals. Early reports cited Aspergillus as the causative organism. It is now recognized that the dematiaceous fungi, including Bipolaris, Culvularia, Exserohilum, and Alternaria are associated with AFS. The disease typically follows a slow, mild course and dose not invade tissue, although pressure in the sinus can eventually cause expansion and erosion of the sinus walls. We report a case who was presented with right facial swelling and numbness, right vision loss, right hearing loss as well as deficit in cranial nerve III, IV, V, VI. A gangrene was found in right upper concha. A biopsy was done and fungal hyphae was noted. The brain MRI revealed right temperal tip abscess; he was then transfered to our ward for further surgeical treatment. The pathological findings revealed Aspergillus. A new diagnostic entity, "skull base allergical fungal sinusitis" (SBAFS) as issued, could corporate the histological diagnostic criteria and the computed tomography of bone erosion in this case. Biopsy in the sinus and the brain is necessary to rule out fungus or tumor invasion. The awareness and corporation between otolaryngologists, ophthalmologists, and neurosurgeone with the disease can avoid delayed diagnosis and promote early treatment.