# Diagnosis of Aspergillus Osteomyelitis of the Clivus and Sella Turcica in a Patient With Type 2 Diabetes and a History of Prolonged Intranasal Corticosteroid Use

## TL;DR

A 69-year-old man with diabetes and corticosteroid use developed a rare fungal infection in his skull base, highlighting the need for early diagnosis and treatment.

## Contribution

This case report adds to the limited literature on Aspergillus osteomyelitis in non-immunocompromised patients.

## Key findings

- Aspergillus species were identified through endoscopic sphenoidotomy in a patient with atypical headaches.
- The case emphasizes the importance of considering fungal infections in diabetic patients with prolonged corticosteroid use.
- Multidisciplinary management, including surgery and antifungal therapy, was crucial for a favorable outcome.

## Abstract

A 69-year-old immunocompetent male with uncontrolled type 2 diabetes mellitus (T2DM) presented with atypical left-sided headaches, diverging from his usual migraine pattern. Historically experiencing right-sided migraines, the patient's shift to left-sided headaches occurred after a month of using fluticasone for cold-like symptoms and potential mold exposure at home. Computed tomography (CT) and magnetic resonance imaging (MRI) suggested the diagnosis of skull base osteomyelitis. Endoscopic sphenoidotomy revealed Aspergillus species, leading to treatment with voriconazole. Despite the rarity of skull base Aspergillus osteomyelitis in patients who are not classically immunocompromised, this case underscores its possibility, especially in the context of diabetes and prolonged corticosteroid use. Similar literature is limited but highlights the high fatality rate of invasive fungal infections in diabetic patients and the complexity of diagnosing skull base osteomyelitis due to its varied presentations. Management involved surgical debridement and systemic antifungal therapy. This case aims to add to the limited literature on cranial Aspergillus osteomyelitis, advocating for heightened clinical vigilance, a multifaceted approach involving prompt evaluation, surgical intervention, and tailored antifungal therapy. The case highlights the need for considering fungal etiologies in atypical headache presentations and emphasizes multidisciplinary management for favorable outcomes in an otherwise morbid condition.