Fungal Sphenoiditis in a Patient With ANCA-associated Vasculitis

Fungal sinusitis comprises a heterogeneous group of diseases differing in etiology, clinical presentation, and pathogenesis. One such form is a mycetoma, a noninvasive form characterized by the accumulation of fungal hyphae and debris within a sinus cavity, without invasion of the mucosa. Isolated sphenoid sinus mycetoma is relatively rare, and its pathophysiology remains incompletely understood. The patient’s immune status plays a critical role in the pathogenesis of fungal sinusitis, as immunosuppression is a major risk factor for the transformation of noninvasive mycetoma into an invasive form, potentially resulting in severe complications. Therefore, immune status assessment in patients with noninvasive fungal sinusitis, particularly in the presence of comorbidities and immunosuppressive therapy, is essential for determining optimal treatment strategies. This article presents a clinical case of fungal sphenoiditis in a female patient with granulomatosis with polyangiitis (ANCA-associated vasculitis) undergoing immunosuppressive therapy. The case is notable for the combination of noninvasive fungal sphenoiditis with a high risk of invasive disease due to immunosuppression. Given the elevated risk, the patient underwent endoscopic sphenoethmoidectomy followed by systemic antifungal therapy. This case highlights the importance of early surgical intervention and appropriate systemic antifungal treatment in preventing infection progression and complications in patients with noninvasive fungal sinusitis, especially in the context of immunosuppression.