Unmasking Aspergillosis: A Rare Cause of Facial Palsy and Vision Loss in an Immunocompetent Patient—A Case Report and Literature Review

We present a case report of a 45-year-old female with acute onset right-sided facial weakness, worsening vision, and diplopia. Upon evaluation, the patient exhibited total right-side facial palsy (House-Brackmann grade IV) with III, IV, and VI Cranial Nerve Ophthalmoplegia. There was no perception of light associated with optic atrophy on ocular examination. Computed tomography and magnetic resonance imaging showed a sizeable sphenoid sinus mass compressing the right optic nerve, consistent with neoplasia or invasive fungal infection. Eventually, we removed the mass endoscopically through a transnasal approach and diagnosed it as invasive Aspergillosis on histopathological examination, even though no previous record of immunodeficiency existed. The patient received intravenous followed by oral voriconazole. Postoperatively, there was partial recovery of her facial nerve function. This case highlights the importance of considering invasive fungal infections, even in immunocompetent patients, when managing space-occupying lesions with neuro-ophthalmic involvement.