Sinonasal aspergillosis-associated pneumocephalus in a dog: recovery after endoscopic interventional debridement and antifungal treatment

Abstract

A 16-year-old Border Collie was referred for acute severe apathy and chronic nasal discharge. Computed tomography (CT) performed 2 weeks earlier was suggestive of sinonasal aspergillosis (SNA) with severe turbinate destruction and mucosal thickening in the left nasal cavity and frontal sinus. No treatment was initiated. Magnetic resonance imaging (MRI) at presentation identified intrameningeal pneumocephalus, meningitis, frontal sinusitis with ventral focal frontal bone lysis of the cranial cavity. Cerebrospinal fluid analysis was unremarkable, suggesting pneumocephalus as the cause of apathy. Rhinoscopy confirmed fungal plaque (qPCR: Aspergillus spp.). Systemic antifungal treatment and endoscopic debridement were initiated. Despite frontal bone lysis, topical antifungal treatment also was administered. A 3-week follow-up MRI showed complete resolution of pneumocephalus. Final imaging identified scarring around the defect and no active infection. These findings indicate that intrameningeal pneumocephalus secondary to SNA can be reversible and should not preclude antifungal treatment. Endoscopic therapeutic intervention may enable full recovery.