Bilateral visual loss from sphenoidal sinus Aspergillosis

Abstract

Sphenoidal sinus aspergillosis is a rare disease which is difficult to diagnose due to its protean presentations.

This report aims to describe bilateral loss of vision in a woman with insulin-dependent diabetes mellitus following aspergillosis of the right sphenoidal sinus. A 59-year old woman with insulin-dependent diabetes mellitus presented with a right-sided frontal headache of sudden onset which was associated with blurring of vision, all of two days duration. Her vision with correction was initially normal at 6/9 in each eye and funduscopy was normal. Two weeks into the illness, the vision became nil perception of light in the right eye. The persistence of a headache coupled with loss of vision in the left eye five months later led to neurosurgical evaluation and subsequent craniotomy. At craniotomy, pus and inflammatory tissue were found matting together the optic nerves and chiasma. Histology of the specimen showed features of aspergillosis.  This case was instructive due to the rarity of sphenoidal aspergillosis/fungus ball involving the sellar/parasellar region. Delay in management can lead to blindness from optic nerve/chiasma involvement. Therefore, a high index of clinical suspicion is required although CT scan and MRI are the ultimate diagnostic tools.