Invasive fungal sphenoidal sinusitis – A rare case report

We report the case of a 44-year-old female patient undergoing immunosuppression due to a liver transplant. Four months after the transplant, she developed headaches refractory to treatment, with no pathological findings on the cranial magnetic resonance imaging (MRI) performed. Over the course of seven months, she continued to experience refractory headaches despite different therapeutic regimens for migraines. Gradually, she developed diplopia and decreased visual acuity, prompting a repeat imaging study. The new cranial MRI revealed cavernous sinus thrombosis, raising suspicion of invasive fungal sphenoidal sinusitis. The patient underwent medical treatment (amphotericin B followed by voriconazole, for a total of 12 weeks) and surgical intervention (endoscopic sphenoidotomy with debridement of the fungal lesion). The day after the surgical procedure, the patient reported immediate relief from headaches. After two years of follow-up, despite ophthalmologic sequelae (limited abduction of the left ocular globe), there was a complete resolution of the headaches.