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KMID : 0984720030350050310
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Infection and Chemotherapy
2003 Volume.35 No. 5 p.310 ~ p.314
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A Case of Invasive Aspergillosis of Skull Base in a Diabetic Patient
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Lee Ji-Yeon
Kim Sung-Bum
Kim Yong-Hyun
Kim Jeong-Han
Yu Sang-Kyun
Kim Hee-Young
Jung Young-Kul
Park Seung-Chul
Jung Hak-Hyun
Choe Jae-Gol
Lee Jin-Soo
Kim Min-Ja
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Abstract
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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--yearold diabetic female patient presented with headache and otalgia 4 months after surgery for noninvasive 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 noninvasive 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 deter-mining the presence and extent of the disease, and monitoring clinical response following therapy.
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KEYWORD
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Aspergillosis, Skull base, Amhotericin B, Gallium scan
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