Work

Beyond Incidental Sinusitis: Acute Invasive Fungal Rhinosinusitis with Intracranial Extension. A Case Report with Radiologic‐Pathologic Correlation

Year: 2026

Type: article

Abstract: ABSTRACT Background Acute invasive fungal rhinosinusitis (AIFRS) represents a diagnostic emergency where imaging findings often precede clinical deterioration. While paranasal sinus opacification is commonly encountered in radiology practice, the distinction between benign inflammatory disease and angioinvasive fungal infection carries profound therapeutic implications. This case illustrates the importance of recognizing subtle radiologic red flags that transform “incidental sinusitis” into a life‐threatening diagnosis. Case Presentation A 47‐year‐old male with poorly controlled type II diabetes mellitus (HgbA1c of 9.8%) presented to the radiology department with a 15‐day history of headache, vomiting, and giddiness. Contrast‐enhanced MRI revealed a large extra‐axial lesion centered in the anterior cranial fossa measuring 5.1 × 4.5 × 5.1 cm 3 , characterized by T2W hypointensity, diffusion restriction, and heterogeneous enhancement. Imaging demonstrated multi‐compartmental bony erosion involving the cribriform plate, sphenoid sinus roof, bilateral ethmoidal air cells, and medial orbital walls, with intracranial extension into the bilateral basifrontal lobes causing mass effect and early subfalcine herniation. Orbital involvement with optic nerve encasement was also demonstrated. Histopathology confirmed invasive aspergillosis with characteristic septate, acute‐angle branching hyphae and infarct necrosis. The patient got a multidisciplinary management involving trans‐nasal clearance and bi‐frontal craniotomy, followed by liposomal amphotericin B therapy. Conclusion This case highlights that sinusitis on imaging must never be dismissed as incidental in immunocompromised patients. The radiologist serves as the front‐line diagnostician, where recognition of bone erosion, T2 hypointensity, diffusion restriction, and extra‐sinus extension mandates immediate clinical correlation and surgical consultation.

Source: Clinical neuroimaging.

DOI: 10.1002/neo2.70081

Authors: Ampuriire Nyakubaho, Nyakake Juliet, Monica Acen Okwir, Brendah Ayikoru, Joseph Ochom, Patricia Komuhangi

Institutions: Ernest Cook University, Makerere University, Butabika Hospital

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,100