Rapid development of bilateral internal carotid artery aneurysm from sphenoid sinus aspergillosis

The purpose of this case report is to familiarize the sinus surgeon with th e possibility of the rapid development of internal carotid artery aneurysms from fungal infections of the sphenoid sinuses, A renal dialysis patient w ith progressive loss of vision was treated with high doses of steroids for the presumed diagnosis of temporal arteritis. Subsequent work-up included a magnetic resonance arteriogram (MRA) and computed tomography (CT) with con trast that failed to demonstrate aneurysmal changes of the carotid arteries but suggested the presence of a mycotic infection of the sphenoid sinuses. During a sphenoidotomy two days later, in addition to the anticipated aspe rgillus infection of the sinuses, an aneurysm extending from the left inter nal carotid artery into the sphenoid sinus was encountered. An emergency ar teriogram immediately following the surgery revealed a second newly develop ed large mycotic aneurysm of the right internal carotid artery filling the right sphenoid sinus as well. This case report documents the rapidity with which mycotic aneurysms can develop from a sphenoid sinus infection seconda ry to aspergillosis in an immuno-compromised host.