Allergic fungal sinusitis with extensive bone erosion of the clivus presenting with diplopia

We report a case of allergic fungal sinusitis causing bone erosion and diplopia. A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a V...

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Bibliographic Details
Published in:Journal of laryngology and otology 2009-07, Vol.123 (7), p.817-819
Main Authors: Reitzen, S D, Lebowitz, R A, Jacobs, J B
Format: Article
Language:English
Subjects:
Adult
Allergy
Biological and medical sciences
Bone Resorption - etiology
Clivus
Diplopia - etiology
Diplopia - surgery
Endoscopy
Fungal Infection
Humans
Male
Medical sciences
Mycoses - complications
Mycoses - diagnosis
Mycoses - surgery
Nasal Polyps - complications
Nasal Polyps - surgery
Non tumoral diseases
Oculomotor disorders
Ophthalmology
Otorhinolaryngology (head neck, general aspects and miscellaneous)
Otorhinolaryngology. Stomatology
Rhinitis, Allergic, Perennial - diagnosis
Sinusitis
Sinusitis - complications
Sinusitis - diagnosis
Sinusitis - surgery
Tomography, X-Ray Computed
Treatment Outcome
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Summary:We report a case of allergic fungal sinusitis causing bone erosion and diplopia. A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia. Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault.
ISSN:0022-2151
1748-5460
DOI:10.1017/S0022215108003459