An 18-year-old woman with insulin-dependent diabetes mellitus developed an infection of the paranasal sinuses with Rhizopus oryzae resulting in facial swelling, hemiplegia and blindness of the right eye. The therapy of this rhinocerebral mucormycosis consisted of extensive surgical debridement, administration of high-dose amphotericin B, hyperbaric oxygen and control of the underlying predisposing diabetes mellitus. The patient eventually recovered with however, the loss of one eye.

Aspergillosis is increasingly being recognised as a common fungal infection of the paranasal sinuses. Although the disease is almost endemic in neighbouring Sudan, there are few reported cases from the Kingdom of Saudi Arabia. We report four cases of sinus aspergillosis with involvement of the skull bases and/or intracranial spread; a condition we have termed rhinocerebral aspergillosis. Invasive aspergillosis in our subgroup of patients occurs in otherwise healthy patients with normal immune status, quite unlike most reported cases in the western literature. The causative agent in all our patients was identified as aspergillus flavus, similar to patients reported from Sudan. This is again at variance with the case reports from other geographical locations, where aspergillus fumigatus is the commonest causative agent. Saudi Arabia would appear to represent a distinct geographical enclave, together with Sudan, where rhinocerebral aspergillosis of the sinuses and skull base may be more common than has previously been realised.