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Aspergillus pachymeningitis mimicking nasopharyngeal carcinoma

  • H S Chan (a1), H Y Yuen (a2), W K Ng (a3), A C Vlantis (a1), A T Ahuja (a2), C F M Tong (a1) and C A van Hasselt (a1)...

Abstract

Objectives:

We report a case of otogenic fungal pachymeningitis in a diabetic patient who presented with multiple cranial nerve palsies and nasopharyngeal swelling.

Methods:

We present a case report, we describe the investigations, management and clinical course of fungal pachymeningitis, and we present a review of the world literature on fungal and non-fungal pachymeningitis.

Results:

To our knowledge, this is the first report of fungal pachymeningitis with magnetic resonance imaging features suggestive of nasopharyngeal carcinoma. It is also the first reported case with aspergillus cultured from both a dural biopsy and the ear canal.

Conclusion:

Fungal pachymeningitis is a rare condition which may present to otorhinolaryngologists. Its clinical and radiological findings can be confused with those of nasopharyngeal carcinoma; fungal pachymeningitis should thus be included in the differential diagnosis of nasopharyngeal carcinoma.

Copyright

Corresponding author

Address for correspondence: Dr H S Chan, Department of Otorhinolaryngology Head and Neck Surgery, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China Fax: 852 2632 4679 E-mail: dearhs@gmail.com

References

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1 Kupersmith, MJ, Martin, V, Heller, G, Shah, A, Mitnick, HJ. Idiopathic hypertrophic pachymeningitis. Neurology 2004;62:686–94
2 Hatano, N, Behari, S, Nagatani, T, Kimura, M, Ooka, K, Saito, K et al. Idiopathic hypertrophic cranial pachymeningitis: clinicoradiological spectrum and therapeutic options. Neurosurgery 1999;45:1336–42
3 Rossi, S, Giannini, F, Cerase, A, Bartalini, S, Tripodi, S, Volpi, N et al. Uncommon findings in idiopathic hypertrophic cranial pachymeningitis. J Neurol 2004;251:548–55
4 Murai, H, Kira, J, Kobayashi, T, Goto, I, Inoue, H, Hasuo, K. Hypertrophic cranial pachymeningitis due to Aspergillus flavus. Clin Neurol Neurosurg 1992;94:247–50
5 Ismail, AR, Clifford, L, Meacock, WR. Compressive optic neuropathy in fungal hypertrophic cranial pachymeningitis. Eye 2007;21:568–9
6 Iwasaki, S, Ito, K, Sugasawa, M. Hypertrophic cranial pachymeningitis associated with middle ear inflammation. Otol Neurotol 2006;27:928–33
7 Kanzaki, S, Inoue, Y, Watabe, T, Ogawa, K. Hypertrophic chronic pachymeningitis associated with chronic otitis media and mastoiditis. Auris Nasus Larynx 2004;31:155–9
8 Wasser, SP, Weis, AL. Therapeutic effects of substance occurring in higher Basidiomycetes mushrooms: a modern perspective. Crit Rev Immunol 1999;19:6596
9 Bart-Delabesse, E, Basile, M, Al Jijakli, A, Souville, D, Gay, F, Philippe, B et al. Detection of aspergillus galactomannan antigenemia to determine biological and clinical implications of beta-lactam treatments. J Clin Microbiol 2005;43:5214–20
10 Vlantis, AC, Tsang, RK, Yu, BK, Kam, MK, Tong, MC, Lo, PS et al. Nasopharyngectomy and surgical margin status: a survival analysis. Arch Otolaryngol Head Neck Surg 2007;133:1296–301
11 Pak, MW, Chan, KL, van Hasselt, CA. Retropharyngeal abscess. A rare presentation of nasopharyngeal carcinoma. J Laryngol Otol 1999;113:70–2

Keywords

Aspergillus pachymeningitis mimicking nasopharyngeal carcinoma

  • H S Chan (a1), H Y Yuen (a2), W K Ng (a3), A C Vlantis (a1), A T Ahuja (a2), C F M Tong (a1) and C A van Hasselt (a1)...

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