title: Aspergillus petrous apicitis associated with cerebral and peritubular abscesses in an immunocompetent man.
abstract: BACKGROUND
  Petrous apex aspergillosis is an uncommon and dangerous condition, with only four previously reported cases. As with other forms of petrous apicitis, the clinical symptoms are often non-specific and this contributes to diagnostic delay. This paper presents the first reported case of Aspergillus petrous apicitis associated with an intracranial or nasopharyngeal abscess.
  
  
  METHODS
  A 72-year-old man with chronic otorrhoea developed neuralgic headaches and progressive lower cranial nerve palsies despite antibiotic therapy. Imaging revealed petrous apicitis, a temporal lobe abscess and nasopharyngeal abscess. Analysis of biopsy tissue indicated invasive aspergillosis. The patient recovered on a protracted course of voriconazole in addition to medium-term antibiotic therapy.
  
  
  CONCLUSIONS
  Invasive fungal disease should be considered early in the course of skull base osteomyelitis that is clinically unresponsive to empirical broad spectrum antibiotics. This paper highlights the role of tissue biopsy in diagnosis, and the efficacy of voriconazole therapy without the need for radical surgery.
authors: Department of Otolaryngology Head and Neck Surgery, Royal Preston Hospital, UK. bhatt_ym@yahoo.co.uk
authors: Y M
authors: YM
authors: Bhatt
authors: N
authors: N
authors: Pahade
authors: B
authors: B
authors: Nair
mesh_terms: D058888:14-alpha Demethylase Inhibitors; D000038:Abscess / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus; D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D057210:Delayed Diagnosis; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D020953:Neuroaspergillosis; D059270:Petrositis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011743:Pyrimidines / Q000627:therapeutic use; D011859:Radiography; D019291:Skull Base / Q000000981:diagnostic imaging; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D058888:14-alpha Demethylase Inhibitors; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole