A Rare Presentation of Granulomatous Fungal Sinusitis with Optic Nerve Involvement- A Case report

A 30 year old male presented with a history of gradual onset diminution of vision on right eye along with a painless swelling over right forehead with right nasal obstruction and discharge for 4 months. Contrast CT of paranasal sinuses was done and endoscopic sinus surgery was performed. Post operative biopsy showed granulomatous inflammation with hyaline septate hyphae suggestive of Aspergillus. After 1gm of Amphotericin B, patient was discharged on oral voriconazole of which he wasn’t compliant. He presented after 3 months with total loss of vision on right eye and temporal field loss of vision on left eye. MRI brain was done which showed nodular thickening of right optic nerve upto optic chiasma. Revision surgery was performed and patient received oral anti fungal for 6 months post operatively and did not show any evidence of recurrence or disease progression.