Isolated Sphenoidal Fungal Sinusitis in a Patient with Ulcerative Colitis on Steroids

Abstract

Isolated sphenoid sinus lesions are rare, and account for 1-2.7% of all paranasal sinus lesions1. These lesions are sphenoid cyst, sphenoid sinusitis, fungal disease, inverted papilloma, sphenochoanal polyp, foreign body, malignant tumors. Isolated sphenoidal sinusitis can be bacterial or fungal and the incidence of fungal infection is about 25-30% of all and this is categorized as non-invasive, invasive indolent and fulminant2. Noninvasive fungal sinusitis usually involves only one sinus and out of all para-nasal sinuses, commonest to be involved is the maxillary sinus and the commonest organism being aspergillus3. Isolated sphenoidal sinus fungal disease is rare as a result of the unfavorable anatomic location of the sphenoids and decreased nasal airflow in that region4. This disease is more common in immune-compromised patients, but there are cases reported in immune-competent individuals as well5. Since isolated sphenoidal fungal sinusitis is rare, and also because it presents with a range of non-specific symptoms, such as headache, visual symptoms or cranial nerve palsies, the diagnosis can be easily missed if not for a higher degree of suspicion. The diagnosis of isolated sphenoidal fungal sinusitis usually requires advanced imaging because, nasal endoscopy and sinus X-ray can be normal in these patients. Due to all these reasons, the literature reveals, that the diagnosis of fungal sinusitis in sphenoid sinus is often delayed, where the patients suffer for years with headache or deteriorate with complications. We report a case of isolated sphenoidal sinus fungal sinusitis, in a patient with ulcerative colitis in remission, presenting with severe unilateral headache and facial numbness leading to a diagnostic dilemma in the initial stage. This elaborates the importance of a high degree of suspicion of this rare disease in this type of a clinical presentation, to image early and prevent further serious complications.