We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease.
Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language.
Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each).
The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases.
Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.

Craniocerebral eumycetomas are rare. They usually present with scalp swelling and discharging sinuses. Radiologically, they present as space-occupying lesions. We report a case of eumycetoma involving the left parietal cortex, bone, and subcutaneous tissue in a young male, farm laborer, who presented with seizures and blurring of vision. Imaging showed a dural based lesions enhancing moderately on contrast. To the best of our knowledge and belief, ours is the first published case in the English Literature where a eumycetoma has presented as a mass lesion without discharging sinuses. It is imperative to keep such atypical features of an infective etiology in mind because they may be one of differentials of \"dural\" based lesions where only a biopsy may suffice in the absence of significant mass effect to prove the diagnosis.