title: A case of hypertrophic cranial pachymeningitis associated with invasive Aspergillus mastoiditis.
abstract: We report a rare case of hypertrophic cranial pachymeningitis (HCP) associated with invasive Aspergillus mastoiditis. A 63-year-old man with diabetes mellitus underwent mastoidectomy because of chronic discharge from his left ear. The mastoidectomy was unsuccessful in resolving purulent otorrhea; moreover, 7 months later, the patient developed left abducens nerve palsy. Magnetic resonance imaging revealed HCP at the left middle cranial fossa. Although the pathogen could not be identified, an Aspergillus infection was considered based on elevated serum β-d-glucan and a positive Aspergillus antigen test result. Voriconazole treatment resolved diplopia and left otorrhea and dramatically improved HCP.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan. Electronic address: okadama@m.ehime-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Okada
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
authors.forename: Naohito
authors.initials: N
authors.lastname: Hato
authors.affiliation: Departments of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Sato
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hakuba
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan; Department of Otolaryngology, Takanoko Hospital, 525-1 Takanoko, Matsuyama, Ehime, Japan.
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Gyo
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D035301:Cranial Fossa, Middle; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: Aspergillus antigen; Hypertrophic cranial pachymeningitis; Voriconazole