DOI: https://doi.org/10.36347/sjmcr.2025.v13i07.046

Pages: 1702-1704

Fungal rhinosinusitis is a common condition of the paranasal sinuses. The fungal ball (FB) is defined as an extramucosal accumulation of fungal elements filling one or more sinuses, most frequently the maxillary sinus. Sphenoid sinus involvement is rare, but represents a potentially serious condition due to its proximity to critical neuro-ophthalmic structures. Clinical presentation is often nonspecific and may be overlooked, especially in immunocompetent patients. However, characteristic imaging findings on computed tomography (CT), such as a spontaneously hyperdense lesion without contrast enhancement, is the key for diagnosis. Endoscopic sphenoidotomy remains the gold standard treatment and usually allows complete removal of the fungal material. We report the case of a 78-year-old immunocompetent patient presenting with progressive unilateral visual loss. CT and Cone Beam imaging revealed an isolated fungal ball in the left sphenoid sinus. Surgical treatment via endonasal sphenoidotomy led to a favorable outcome and visual stabilization. This case highlights the importance of considering sphenoid fungal sinusitis in the differential diagnosis of unexplained visual symptoms, and emphasizes the value of early ENT evaluation and surgical management.