Invasive paranasal sinus fungal infection developing orbital apex syndrome and causing internal carotid artery infiltration: reports of 3 cases

Fungal infection is an increasing problem in patients treated with intensive chemotherapy or immunosuppressive therapy. Of these, invasive aspergillosis or mucormycosis on rare occasions, infiltrate the internal carotid artery (ICA) by contiguous spread from an infected paranasal sinus. Here, we report three cases of ICA infiltration secondary to the fungal infections of the paranasal sinus. All cases developed orbital apex syndrome when the lesion spread to the orbital apex or cavernous sinus, and aggressive progression led to ICA invasion causing life-threatening cerebral infarction or hemorrhage. In this case report, we describe the aggressive clinical course of the fungal ICA invasion from the paranasal sinus, and then discuss the clinical feature, diagnostic methods, and current treatment of intracranial fungal infection.