Page 104 - ITPS-8-2

INNOSC Theranostics and
Pharmacological Sciences Fungal markers in intracranial fungal infections

rhinorrhea of the right eye, which progressed to painless 2.10. Case 10
visual loss. CT PNS exhibited thickening of the soft tissues A 36-year-old woman presented with a headache and left
along the right optic canal, further compressing the optic maxillary swelling. The fungal assays revealed positive
nerve. The serum was positive for BDG. GM and BDG titers. Consistent with the clinical features,
2.4. Case 4 magnetic resonance angiography, and venography
revealed abnormal signal intensity of fungal colonization,
A 30-year-old woman presented with a 3-month history infiltrative soft tissue thickening, optic nerve encasement,
of headaches and vomiting. A plain CT PNS revealed and ICA attenuation.
a complete opacification of the sphenoid sinus, right
posterior ethmoid air cells, and right frontal sinus, 2.11. Case 11
indicating superadded fungal colonization. The serum A 35-year-old man presented with chronic right-sided
BDG titers were elevated. headaches. The serum was positive for BDG. CSF analysis

2.5. Case 5 revealed an elevated protein level, normal glucose level,
and 95% lymphocytes. Brain MRI revealed fungal sinusitis
A 40-year-old woman presented with headaches. The with cribriform plate erosion and orbital apex extension.
fungal assay was positive, revealing elevated BDG levels.
CSF analysis revealed a normal glucose, an elevated 2.12. Case 12
protein level, and 20% polymorphs. The gram staining and A 27-year-old man presented with a chronic history of
cryptococcal antigen test yielded negative results. headaches, facial numbness, burning sensation over the
2.6. Case 6 upper right side of the face, diplopia, and fever. CT PNS
revealed sphenoid sinus opacification and cavernous sinus
A 32-year-old man presented with headache, right extension. Brain MRI revealed sinonasal polyposis with
eyelid drooping, diplopia that progressed to complete fungal colonization and skull base involvement. The serum
ophthalmoplegia and visual loss. A plain CT PNS was positive for GM and BDG. CSF analysis revealed a
revealed mucosal thickening in the right maxillary turbid fluid, high protein content, 90% neutrophils, and
sinus and right posterior ethmoidal air cells, indicating markedly low glucose level.
a fungal sinus disease with intracranial extension. The
fungal biomarkers were negative. CSF analysis revealed (The clinical profile and fungal assays of the patients are
a normal glucose, an increased protein level, and 90% listed in Table 2).
lymphocytes. 3. Discussion
2.7. Case 7 The CNS is an immunologically privileged site with a
A 35-year-old man presented with headaches and left eye specialized comparatively impermeable BBB. However,
pain. Serum fungal biomarkers were negative. Gadolinium- immunocompromised states predispose individuals to
enhanced brain MRI revealed sinonasal fungal colonization opportunistic and pathogenic mycosis. CNS manifestations
with intraorbital and intracranial extensions. typically arise from hematogenous or disseminated
invasion from pulmonary, intestinal, or cardiac sites.
2.8. Case 8 Nevertheless, direct intracranial spread can occur from
A 40-year-old man presented with chronic headaches. CSF the paranasal sinuses, intraorbital extension, petromastoid
analysis revealed a markedly elevated protein level, normal area, and retropharyngeal spaces. Furthermore, the
glucose level, and 95% lymphocytes. The fungal potassium colonization of ventricular drains, shunts, and central
hydroxide prep yielded a negative result, and the serum venous lines placed during trauma management, as well
was positive for BDG. as the colonization during craniotomies, facilitate direct
mycosis implantation. 13
2.9. Case 9
In 2017, Jabeen et al. reported that approximately
An 18-year-old woman presented with headache, eye 1.78% of individuals suffer from serious fungal infections,
pain, blurred vision, nasal blockage, and shortness excluding oral candidiasis, allergic fungal sinusitis, and
of breath. The serum was positive for BDG. CT PNS cutaneous infections. However, the actual burden of
14
revealed sinus opacification and cribriform plate erosion, fungal infections, particularly IFIs, remains unknown
indicating intracranial extension. Brain MRI confirmed because of the lack of centralized surveillance. Compared
the presence of pansinusitis with fungal colonization and with fungal infections, which are usually rare, IFIs
cortical erosion. are rarer. However, they are relatively common in

Volume 8 Issue 2 (2025) 98 doi: 10.36922/itps.4528