PMC10336253_01
Axial non-contrast CT scan of the skull base depicts bony attenuation and erosion of the clivus (red star), bilateral occipital condyles (red arrows), and the left greater sphenoid wing (brown arrows).
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Additionally, mucosal thickening was observed in the sphenoid sinus (Fig. 1).
Axial non-contrast and contrast-enhanced T1-weighted MR images of the skull base reveal replacement of normal fatty marrow in clivus with heterogenous low signal (black star) that depict hyperenhancement in peripheral parts (yellow arrows) and non-enhancing irregular areas in the center (yellow star) implying necrosis (A,B). Axial and coronal contrast-enhanced T1-weighted image at a lower level (C,D) show extension of necrosis to the right occipital condyle that contains hypoglossal canal (gold star), abnormal enhancing tissue at the right jugular fossa(orange arrow) and abnormal diffuse enhancement in the C1 (pink arrows). Axial T2-weighted and contrast-enhanced T1-weighted brain MRI (E,F) depicts the replacement of the normal CSF signal of Meckels cave with enhancing tissue on the right side (white arrows).
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Furthermore, the right cavernous sinus, Meckel's cave, and oval foramen showed involvement, and abnormal enhancement of leptomeninges and dura was observed (Fig. 2).
(A and B): x 400 magnification, Hematoxylin and Eosin stain. Under microscopic examination infiltration of fungal elements with broad pauciseptate hyphae and irregular branching at 90  angles is seen.
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The histopathologic examination confirmed the angioinvasion by fungal hyphae, further confirming the diagnosis (Fig. 3).