Fungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review.
BACKGROUND
Fungal aneurysms of the carotid artery are rare. We report here a case of Aspergillus fumigatus invasive sphenoidal sinusitis complicated by carotid artery aneurysms in a severely neutropenic patient who was successfully treated with a combination of antifungal therapy and embolization of all aneurysms.


RESULTS
Carotid aneurysms were suspected when severe epistaxis occurred during follow-up for sinusitis. MRI angiograph and cerebral angiograph revealed 5 aneurysms involving the right intracavernous carotid artery. Coil endovascular embolization was successfully used for the first time in this context, and the patient is alive 2 years later. We also reviewed the literature and identified 10 cases of fungal carotid artery aneurysms. Aspergillus species was the most common fungal organism. All patients were immunocompromised and had to be treated surgically.


CONCLUSIONS
Internal carotid arterial involvement is a rare but life-threatening complication of invasive fungal sinusitis. Fungal aneurysms should be diagnosed early, so that the embolization procedure can be performed before the occurrence of severe bleeding.
Hot
Arnaud
A
Services des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, France.
Mazighi
Mikaël
M
Lecuit
Marc
M
Poirée
Sylvain
S
Viard
Jean-Paul
JP
Loulergue
Pierre
P
Suarez
Felipe
F
Dupont
Bertrand
B
Merland
Jean-Jacques
JJ
Lortholary
Olivier
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D001228:Aspergillosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D001232:Aspergillus fumigatus; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D002343:Carotid Artery, Internal / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged