gms | German Medical Science

77th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

24.05. - 28.05.2006, Mannheim

Progressive Cranial Nerve Failure by Invasive Intracranial Aspergillosis

Meeting Abstract

  • corresponding author presenting/speaker Peter R. Issing - ENT-Department, Bad Hersfeld, Germany
  • F. Franke - Institute of Pathology, Gießen, Germany
  • Joachim J. Hammersen - ENT-Department, Bad Hersfeld, Germany
  • Ingo Ott - ENT-Department, Bad Hersfeld, Germany

German Society of Otorhinolaryngology, Head and Neck Surgery. 77th Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery. Mannheim, 24.-28.05.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06hno100

The electronic version of this article is the complete one and can be found online at:

Published: September 7, 2006

© 2006 Issing et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.