title: Fungal Mycotic Aneurysm of the Internal Carotid Artery Associated with Sphenoid Sinusitis in an Immunocompromised Patient: A Case Report and Review of the Literature.
abstract: In immunocompromised patients, invasive molds such as Aspergillus and Mucor can lead to locally aggressive angioinvasive infections that are often life-threatening. A particularly devastating complication is the development of a fungal mycotic aneurysm resulting from invasion of the arterial wall. Due to anatomic contiguity, the sphenoid sinus provides potential access for these fungi, which often colonize the respiratory sinuses, into the cavernous sinus and internal carotid artery (ICA), thus leading to the formation of ICA aneurysms. The ideal treatment of fungal ICA aneurysms includes a combination of surgical debridement and long-term effective antifungal therapy, but the role of endoscopic resection and the duration of antimicrobials are poorly defined. Here, we present the case of a 71-year-old immunocompromised patient who developed an ICA mycotic aneurysm, associated with a proven invasive fungal infection (presumptively Mucorales) of the sphenoid sinuses, as defined by EORTC/MSG criteria, and who survived after undergoing coil embolization with parent vessel sacrifice of the aneurysm in combination with liposomal amphotericin B. We also review the literature for published cases of invasive fungal sphenoid sinusitis associated with mycotic aneurysms of the ICA and provide a comparative analysis .
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, PO Box 208022, New Haven, CT, 06520, USA. marwan.azar@yale.edu.
authors.forename: Marwan M
authors.identifier: http://orcid.org/0000-0001-5498-5042
authors.initials: MM
authors.lastname: Azar
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, 06520, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Assi
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, CT, 06520, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Patel
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, PO Box 208022, New Haven, CT, 06520, USA.
authors.forename: Maricar F
authors.initials: MF
authors.lastname: Malinis
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D000785:Aneurysm, Infected / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D000935:Antifungal Agents / Q000008:administration & dosage; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D009090:Mucorales / Q000302:isolation & purification*; D013101:Sphenoid Sinus / Q000473:pathology; D015524:Sphenoid Sinusitis / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B
keywords: Fungal; Mucormycosis; Mycotic aneurysm; Sphenoid sinusitis