Chronic invasive sinus aspergillosis without immunocompromise

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This 68 year man without any known immunodeficiency was diagnosed with A. fumigatus right maxillary sinusitis in August 2005. Maxillotomy with mass removal was performed. Five months later localised relapse with progression to the right orbit was seen. Debridement of maxillary sinus was performed and he was given voriconazole 200 mg twice daily for four weeks. Due to local progression maxillectomy was done 3 months later and amphotericin B introduced for 4 weeks. Despite treatment with amphotericin B and caspofungin, followed by voriconazole, for five and a half months his disease progressed. Posaconazole was started but stopped due to side effects. Voriconazole at a higher dose was reintroduced. Despite continuous voriconazole treatment progression of the disease was demonstrated with localised extension to his brain.


  • Aspergillus fumigatus