# Skull base invasive aspergillosis in a peritoneal dialysis patient: A rare and devastating complication

## TL;DR

A rare and severe fungal infection in a peritoneal dialysis patient leads to life-threatening complications, highlighting the need for early detection and precise treatment.

## Contribution

This is the first documented case of skull base invasive aspergillosis in a peritoneal dialysis patient.

## Key findings

- Invasive Aspergillus flavus mastoiditis progressed to skull base osteomyelitis in a peritoneal dialysis patient.
- Despite aggressive treatment, the infection spread to the carotid sheath and caused severe complications.
- Molecular sequencing confirmed the species as A. flavus, excluding other cryptic species.

## Abstract

Aspergillus mastoiditis with skull base osteomyelitis is an exceptionally rare but life-threatening infection in patients undergoing peritoneal dialysis (PD). We report a 60-year-old man with diabetic kidney failure on PD who developed invasive Aspergillus flavus mastoiditis progressing to skull base osteomyelitis. Despite early mastoidectomy, PD catheter removal, and voriconazole therapy achieving therapeutic levels, the infection advanced to involve the carotid sheath and parapharyngeal space, resulting in severe neurologic and systemic complications. Molecular sequencing confirmed A. flavus, excluding cryptic species such as A. tamarii. This case represents the first documented instance of skull base invasive aspergillosis in a PD patient and underscores the importance of early suspicion, species-level molecular confirmation, and multidisciplinary management in this formidable and rapidly progressive condition.