Sphenoid sinusitis in AIDS, pt LM

CT scan of the sinuses shows a completely opacified sphenoid sinus in this man with AIDS (Khoo S, Denning DW. Invasive aspergillosis in patients with AIDS Clin Infect Dis 1994; 19 (suppl 1): S41-8.) He had complained of headache for about 3 months before this scan was done. In addition to sinus disease, erosion of disease through the left lateral wall of the sinus into the arterior horn of the temporal lobe, can be seen leading to a cerebral abscess. The patient was treated with itraconazole, but had undetectable serum concentrations because of prior phenytoin, and died after nine days of therapy of an MRSA bacteraemia. He was reported as an “other failure” in Denning DW, Lee JY, Hostetler JS, Pappas P, Kauffman CA, Dewsnup DH, Galgiani JN, Graybill JR, Sugar AM, Catanzaro A, Gallis H, Perfect JR, Dockery B, Dismukes WE, Stevens DA, NIAID Mycoses Study Group multicenter trial of oral itraconazole therapy of invasive aspergillosis. Am J Med 1994; 97: 135-144.

Cultures from the sinus and brain abcess grew A.fumigatus.

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