{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T17:32:44Z","timestamp":1781890364635,"version":"3.54.5"},"reference-count":11,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,1]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>We report the case of a previously well 80-year-old man who presented with subacute bilateral painful optic neuropathy with initial response to corticosteroids but ultimately progressed to a fatal skull base syndrome. Initial presentation of steroid-responsive painful bilateral posterior optic neuropathy, preliminary normal enhanced MRI, normal cerebrospinal fluid and inflammatory markers indicated atypical optic neuritis. However, this progressed to a bilateral orbital apex syndrome with ophthalmoplegia and evidence of abnormal skull base enhancement on subsequent MRI. Biopsy of radiologically abnormal dura was non-diagnostic and negative for fungal stains. He deteriorated and died 8\u2009months after initial presentation. At postmortem, fungal skull base infection was diagnosed. This case demonstrates that chronic skull base fungal infection can: (1) present in elderly immunocompetent patients, (2) show initial improvement with corticosteroids and (3) evade diagnosis on biopsy. We encourage a high index of suspicion for fungal skull base infection in similar cases.<\/jats:p>","DOI":"10.1136\/bcr-2018-226998","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"e226998","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Skull base aspergillosis in an immunocompetent elderly man with early response to steroid"],"prefix":"10.1136","volume":"11","author":[{"given":"Pamela","family":"Sarkar","sequence":"first","affiliation":[{"name":"Neurology Department, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Price","sequence":"additional","affiliation":[{"name":"Neurology Department, Taunton and Somerset NHS Foundation Trust, Taunton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Fish","sequence":"additional","affiliation":[{"name":"Neurology Department, Taunton and Somerset NHS Foundation Trust, Taunton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Bennetto","sequence":"additional","affiliation":[{"name":"Neurology Department, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,11,28]]},"reference":[{"key":"2025082712561226000_11.1.e226998.1","first-page":"S37","article-title":"Aspergilloma of the brain: an overview","volume":"51 Suppl 1","author":"Nadkarni","year":"2005","journal-title":"J Postgrad Med"},{"key":"2025082712561226000_11.1.e226998.2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s10072-009-0049-3","article-title":"Fatal Aspergillus brain abscess in immunocompetent patient","volume":"30","author":"Curone","year":"2009","journal-title":"Neurol Sci"},{"key":"2025082712561226000_11.1.e226998.3","doi-asserted-by":"crossref","first-page":"237","DOI":"10.2176\/nmc.34.237","article-title":"Aspergillus brain abscess in a patient with normal immunity\u2013case report","volume":"34","author":"Kawakami","year":"1994","journal-title":"Neurol Med Chir"},{"key":"2025082712561226000_11.1.e226998.4","doi-asserted-by":"publisher","DOI":"10.1016\/0090-3019(93)90145-Q"},{"key":"2025082712561226000_11.1.e226998.5","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1186\/1756-0500-7-689","article-title":"Cerebral aspergillosis in a patient with leprosy and diabetes: a case report.","volume":"7","author":"Segundo","year":"2014","journal-title":"BMC Res Notes"},{"key":"2025082712561226000_11.1.e226998.6","doi-asserted-by":"crossref","first-page":"203.e1","DOI":"10.1016\/j.wneu.2013.08.018","article-title":"Acute chiasmal abscess resulting from perineural extension of invasive sino-orbital aspergillosis in an immunocompetent patient","volume":"81","author":"Leyngold","year":"2014","journal-title":"World Neurosurg"},{"key":"2025082712561226000_11.1.e226998.7","first-page":"36","article-title":"Invasive aspergillosis. 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