Fungal Mycotic Aneurysm of the Internal Carotid Artery Associated with Sphenoid Sinusitis in an Immunocompromised Patient: A Case Report and Review of the Literature

Abstract

In immunocompromised patients, invasive molds such as Aspergillus and Mucor can lead to locally aggressive angioinvasive infections that are often life-threatening. A particularly devastating complication is the development of a fungal mycotic aneurysm resulting from invasion of the arterial wall. Due to anatomic contiguity, the sphenoid sinus provides potential access for these fungi, which often colonize the respiratory sinuses, into the cavernous sinus and internal carotid artery (ICA), thus leading to the formation of ICA aneurysms. The ideal treatment of fungal ICA aneurysms includes a combination of surgical debridement and long-term effective antifungal therapy, but the role of endoscopic resection and the duration of antimicrobials are poorly defined. Here, we present the case of a 71-year-old immunocompromised patient who developed an ICA mycotic aneurysm, associated with a proven invasive fungal infection (presumptively Mucorales) of the sphenoid sinuses, as defined by EORTC/MSG criteria, and who survived after undergoing coil embolization with parent vessel sacrifice of the aneurysm in combination with liposomal amphotericin B. We also review the literature for published cases of invasive fungal sphenoid sinusitis associated with mycotic aneurysms of the ICA and provide a comparative analysis .

Fungal mycotic aneurysm in a patient withAspergillus terreuschronic meningoencephalitis

“…[3] Historically, infectious endocarditis has been considered as the main origin of septic emboli. [25] However, there are multiple other origin sites that should be considered when facing these cases such as cavernous sinus thrombophlebitis, [24] paranasal sinus infections, [4] and, as in our case, following spinal anesthesia. [6,23] Diagnosis still remains a challenge for most physicians, as the distinctive pathological process can only be evidenced through autopsy Aspergillus terreus Death 4 weeks after a presentation from aneurysm rupture Ahuja et al [1] 18 Aspergillus spp.…”

Cavernous Thrombophlebitis Secondary to Cavernous Internal Carotid Mycotic Aneurysm

“…1 Interestingly, the etiology of mycotic cavernous internal carotid artery aneurysms is infrequently endocarditis and more commonly related to nonsystemic pathology such as meningitis, sinusitis, or periodontal disease. [3][4][5][6] Our case is unique in that the etiology was secondary to candida endocarditis. This is the first case of cavernous carotid mycotic aneurysm secondary to candida endocarditis reported in the literature.…”

“…1 Much more common is extravascular etiology secondary to local invasion of the vasculature from a local infection. [3][4][5] The majority of mycotic cavernous carotid artery aneurysms have ultimately been the consequence of bacterial pathogens. 1 More recently, fungal pathogens have been described with Aspergillus 5,6 and mucormycosis 3 previously reported.…”

The Curious Case of “Case Report” of Infections Caused by Human and Animal Fungal Pathogens: An Educational Tool, an Online Archive, or a Format in Need of Retooling

“…Severe paracoccidioidomycosis in a 14-year-old boy 200 1/1 [63] a Google Scholar/Scopus [41,42], France [43,44], India [45,46], Italy [47], Iran [48], Japan [49], Malaysia [50], Poland [51], UK [52], and USA [53,54]. There were no other discernible features among this group of case reports to account for the high downloads and citations except for a novelty or rarity of fungal pathogens, for example reports of two cases of multidrug-resistant yeast (Fereydounia khargensis) and of black-grain eumycetoma caused by the rare fungal pathogen Medicopsis romeroi [50,52].…”