Paresthesia and Facial Bone Destruction due to Chronic Granulomatous Invasive Aspergillosis in the Left Maxillary Sinus

Abstract

We report a case of chronic granulomatous invasive aspergillosis in a 56-year-old male teacher from South Kordofan, Sudan, who underwent surgery in 2007 to remove his left orbital aspergillus granuloma. The patient developed progressive facial swelling beginning in 2017 and paraesthesia in the left zygomatico-maxillary region, despite initial treatment. A soft tissue mass in the left maxillary sinus and widespread bone loss affecting the zygomatic arch, maxillary antrum, and fronto-temporal lytic lesions were seen on computed tomography. Histopathological analysis confirmed the recurrence of aspergillosis. Itraconazole therapy was administered to the patient after surgical excision, although treatment compliance was subpar. A subsequent wide local excision was performed in 2021, but the patient developed post-operative complications, including wound infection and dysphagia, leading to death four days after surgery. This case highlights the aggressive nature of chronic invasive aspergillosis, the importance of adequate initial treatment duration, and the potential for devastating complications, including facial bone destruction and neurological involvement manifesting as paresthesia.