SKULL BASE ALLERGIC FUNGAL SINUSITIS WITH ABDUCENS PALSY IN THE 3RD-TRIMESTER

Allergic fungal sinusitis (AFS) usually follows a slow course, but bon e erosion including that of the skull base can be seen. Patients may p resent with intracranial extension mimicking a cranial base neoplasm. We describe a 21-year-old pregnant female initially seen at 27 weeks g estation with a complete right sixth nerve paralysis. MR imaging showe d an apparent nasopharyngeal neoplasm invading both temporal lobes. Fu rther evaluation revealed ; typical findings of fungal sinusitis on bo th CT and MR images. Biopsy results fulfilled the diagnostic criteria of AFS, and after endoscopic treatment the sixth nerve palsy quickly r esolved. Although abducens palsy has been reported with acute bacteria l sinusitis and with mucocele, and limitation of eye motility has been described with orbital involvement by AFS, we are unaware of any prio r reports of true cranial nerve palsy associated with proven AFS. Our patient had no evidence of mucocele or of bacterial infection. The pal sy in this case was presumably the result of compression of the cavern ous sinus. The patient's pregnancy made decision making regarding imag ing and surgical intervention complex. Mother and child are alive and well 31 months after surgery.