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<p>Cavernous sinus thrombosis (CST) is a rare but life-threatening complication of paranasal sinus infections, most commonly sphenoid sinusitis. Invasive fungal sinusitis due to mucormycosis and aspergillosis is an aggressive cause of CST in diabetics and immunocompromised patients, with high morbidity and mortality. While cranial nerves III, IV, V, and VI are typically involved, lower motor neuron facial palsy and mandibular nerve palsy is exceptionally uncommon. We report a rare case of bilateral CST in an immunocompetent host secondary to mixed fungal sinusitis presenting with facial nerve palsy. A middle-aged immunocompetent female presented with left ear discharge, otalgia, and vertigo, which progressed to include transient decreased visual acuity and cranial nerve deficits. Otoscopic examination and radiological imaging indicated the presence of left-sided chronic otitis media with otomycotic debris, as well as bilateral cavernous sinus thrombosis attributed to fungal sinusitis caused by<i> Aspergillus</i> species. The patient exhibited multiple cranial neuropathies, specifically bilateral abducens palsy, right lower motor neuron facial palsy, and involvement of the right trigeminal nerve (V3). Management strategies included the administration of systemic antifungal agents (liposomal amphotericin B and voriconazole), anticoagulation therapy, and endonasal surgical debridement, which collectively resulted in significant clinical improvement. This case highlights a unique occurrence of fungal cavernous sinus thrombosis, accompanied by facial nerve paralysis, in an immunocompetent patient. Maintaining a high level of clinical suspicion, even in individuals who are not immunocompromised is important. Timely radiological evaluation, proactive antifungal treatment, and swift surgical action are essential for improving the outlook for such a fulminant infection.</p>

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Concurrent Fungal Infections Leading to Cavernous Sinus Thrombosis and Facial Palsy in an Immunocompetent Host

  • 期刊论文

  • 发表日期：

    2026年7月11日

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  • Astha Kesarwani,
  • Annanya Soni,
  • Kushal Singh,
  • Arijit Jotdar,
  • Shrinkhal,
  • Amit Kumar Gupta

摘要

Cavernous sinus thrombosis (CST) is a rare but life-threatening complication of paranasal sinus infections, most commonly sphenoid sinusitis. Invasive fungal sinusitis due to mucormycosis and aspergillosis is an aggressive cause of CST in diabetics and immunocompromised patients, with high morbidity and mortality. While cranial nerves III, IV, V, and VI are typically involved, lower motor neuron facial palsy and mandibular nerve palsy is exceptionally uncommon. We report a rare case of bilateral CST in an immunocompetent host secondary to mixed fungal sinusitis presenting with facial nerve palsy. A middle-aged immunocompetent female presented with left ear discharge, otalgia, and vertigo, which progressed to include transient decreased visual acuity and cranial nerve deficits. Otoscopic examination and radiological imaging indicated the presence of left-sided chronic otitis media with otomycotic debris, as well as bilateral cavernous sinus thrombosis attributed to fungal sinusitis caused by Aspergillus species. The patient exhibited multiple cranial neuropathies, specifically bilateral abducens palsy, right lower motor neuron facial palsy, and involvement of the right trigeminal nerve (V3). Management strategies included the administration of systemic antifungal agents (liposomal amphotericin B and voriconazole), anticoagulation therapy, and endonasal surgical debridement, which collectively resulted in significant clinical improvement. This case highlights a unique occurrence of fungal cavernous sinus thrombosis, accompanied by facial nerve paralysis, in an immunocompetent patient. Maintaining a high level of clinical suspicion, even in individuals who are not immunocompromised is important. Timely radiological evaluation, proactive antifungal treatment, and swift surgical action are essential for improving the outlook for such a fulminant infection.