Fungal colonization at the site of skull base injury: A case report

This is the first case report of a cerebrospinal fluid leak secondary to a traumatic nasopharyngeal swab in association with a non-invasive fungal ball. Both fungal balls and skull base fractures are known to incite localized inflammatory changes, possibly contributing to progression of the other. In this case, prior nasopharyngeal trauma and resulting mucosal irritation could have provided an ideal location for fungal colonization. Additionally, fungal balls initiate localized inflammation and subsequent bony erosion, creating an environment conducive to delayed fracture healing after trauma. This case highlights the importance of continued surveillance of skull base fractures and heightened awareness of occult fractures underlying fungal balls. It also raises awareness of association between these two pathologies with more research necessary to determine correlation between the sequelae of traumatic skull base injuries and fungal colonization. • Traumatic COVID-19 swab is the proposed mechanism of skull base trauma in this case, compounded by development of overlying fungal ball. • Both fungal balls and skull base fractures incite surrounding inflammation, possibly encouraging progression of one another. • This case highlights necessary surveillance of skull base fractures and fungal balls and encourages further research into the relationship.