Aspergillosis of the petrous apex

We present the case of an immunocompetent man who presented with multiple and progressive cranial nerve palsies. The cause was found to be aspergillosis of the petrous bone, arising as a result of chronic fungal otitis media. Despite treatment with local excision and systemic anti-fungal therapy, he died after suffering a subarachnoid haemorrhage. Diagnosis rests upon prompt radiological imaging and the acquisition of tissue for histological examination and culture but cannot be made without awareness of the condition.