Chronic invasive Aspergillus Fumigatus rhinosinusitis with intracranial extension.

A 63-year-old male with type 2 diabetes mellitus (hemoglobin A1c: 8.2%) presented with progressively worsening blurry vision, headache, and unsteadiness. MRI of the brain and orbit revealed an infiltrating lesion at the cribriform plate with orbital and intracranial involvement. After extensive diagnostic evaluation including repeat biopsies, DNA analysis on biopsied tissue ultimately revealed Aspergillus fumigatus. During several multidisciplinary discussions with the patient and his family, surgical intervention was decided against due to associated morbidity and concern for adequate source control. Despite intensive antifungal medication management, including amphotericin, isavuconazole, and micafungin, for more than a year, there was disease progression with vision loss and brain abscess formation. This case highlights the diagnostic challenges contributing to the poor prognosis associated with chronic invasive fungal rhinosinusitis and the need for early evaluation and multidisciplinary intervention.