Fungus That Struck the Brain: A Case of Invasive Sino-Orbital Aspergillosis Causing a Stroke

TL;DR

A rare fungal infection in a diabetic man led to a stroke, highlighting the need for early diagnosis and multidisciplinary treatment.

Contribution

This case report demonstrates the rare complication of stroke caused by invasive sino-orbital aspergillosis.

Findings

Invasive sino-orbital aspergillosis can cause internal carotid artery invasion and stroke.

Early diagnosis and multidisciplinary treatment are crucial to prevent fatal outcomes.

The patient improved with antifungal therapy and mechanical thrombectomy.

Abstract

Invasive sino-orbital aspergillosis is a rare but potentially fatal fungal infection that predominantly affects immunocompromised individuals. It can lead to severe complications such as internal carotid artery invasion and ischemic stroke. We report a case of a 74-year-old male patient with uncontrolled diabetes mellitus who presented with right eye pain and proptosis. Imaging revealed a sino-orbital mass with invasion into the cavernous sinus and internal carotid artery. Following a biopsy, the patient suffered an ischemic stroke due to the right internal carotid artery occlusion, requiring mechanical thrombectomy and stent placement. Histopathology confirmed Aspergillus fumigatus, and the patient was treated with amphotericin B and voriconazole, showing improvement. This case highlights the importance of early diagnosis and a multidisciplinary approach in managing invasive sino-orbital aspergillosis to prevent fatal vascular complications.

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