gms | German Medical Science

Contrary to the more common hematogeneous spread localized invasive intracranial aspergillosis is a fungal infection which may be difficult to diagnose. This disease can also occur in patients without severe immunosuppression.

We report on the case of an 84 years old female patient with a mild diabetes, who developed chronic discharge in the right ear in spring 2004. Otoscopy showed a central perforation of the ear drum, which was repaired by a tympanoplasty with an underlay transplant of tragal cartilage. The postoperative course was uneventfull till summer when the patient developed a facial palsy. High-Resolution-CT-scan of the temporal bone revealed an opacity of the ipsilateral mastoid, which was explored by conservative mastoidectomy. The histological specimen demonstrated a chronic unspecific inflammation. Beside the facial palsy, which was unchanged, the patient developed a failure of the following cranial nerves till November 2004: Nn. V, VI, VII, IX and X. A thorough internal and neurological examination could not detect the etiology of the patient´s illness. Imaging (CT, MRI, SPECT) revealed a blocked right mastoid and an enhancement of the dura of the posterior fossa. As the patient´s status continuously worsened we decided to surgically explore the temporal bone again. In the region of the endolymphatic sac the tissue was macroscopically altered. The pathological examination by frozen section could diagnose an invasive intracranial aspergillosis, which could be confirmed by immunohistology. Despite the immediate and intensive treatment wit caspofungin, a newly developed antifungal echinocandin, the patient died in multi-organ failure.