{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:07Z","timestamp":1756425787192,"version":"3.44.0"},"reference-count":31,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,10,28]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>We describe the case of a 32-year-old man from Cape Verde having headache and increasing visual loss. Clinical and radiological investigations disclosed a massive destructive lesion involving the anterior and central skull base, orbit and nasoethmoid region initially interpreted as a malignant small round cell tumour. Surgical biopsies were negative for neoplasm, showing an intense inflammatory infiltrate together with fungus, later characterised as <jats:italic>Aspergillus flavus<\/jats:italic> spp. The patient was immunocompetent with no evidence of congenital or acquired immunodeficiencies. Invasive fungal infections in immunocompetent patients are rare and can be a diagnostic challenge. The best diagnostic clues include the patient\u2019s origin from tropical climates, imaging features and the identification of fungal hyphae on pathology specimens. Although a devastating disease in immunocompromised patients, craniocerebral aspergillosis in immunocompetent patients carries a better prognosis. Available literature supports the combined used of \u2018conservative\u2019 surgical resection and antifungal therapy as the best treatment option.<\/jats:p>","DOI":"10.1136\/bcr-2021-245517","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T11:32:22Z","timestamp":1636716742000},"page":"e245517","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Invasive aspergillosis of the skull base in an immunocompetent patient: a diagnostic challenge"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-3054","authenticated-orcid":false,"given":"Alexandra","family":"Borges","sequence":"first","affiliation":[{"name":"Department of Radiology, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7268-7495","authenticated-orcid":false,"given":"L\u00ecgia","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Pacheco","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Pathology, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"2025082801065378000_14.11.e245517.1","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1038\/s41433-019-0358-6","article-title":"Invasive sino-orbital fungal infections in immunocompetent patients: a clinico-pathological study","volume":"33","author":"Adulkar","year":"2019","journal-title":"Eye"},{"key":"2025082801065378000_14.11.e245517.2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000134597.94269.48"},{"key":"2025082801065378000_14.11.e245517.3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.mmcr.2018.10.006","article-title":"Invasive fungal infection by Aspergillus flavus in immunocompetent hosts: A case series and literature review","volume":"23","author":"Garcia-Giraldo","year":"2019","journal-title":"Med Mycol Case Rep"},{"key":"2025082801065378000_14.11.e245517.4","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.nic.2009.06.001","article-title":"Imaging of the central skull base","volume":"19","author":"Borges","year":"2009","journal-title":"Neuroimaging Clin N Am"},{"key":"2025082801065378000_14.11.e245517.5","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1148\/rg.2020190119","article-title":"MRI of rhabdomyosarcoma and other soft-tissue sarcomas in children","volume":"40","author":"Inarejos Clemente","year":"2020","journal-title":"Radiographics"},{"key":"2025082801065378000_14.11.e245517.6","doi-asserted-by":"crossref","unstructured":"Midyett FA , Mukherji SK . 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