Outcomes of three patients with intracranially invasive sino-orbital aspergillosis

Ophthalmic Plast Reconstr Surg. Sep-Oct 2007;23(5):400-6. doi: 10.1097/IOP.0b013e31814db448.

Abstract

Purpose: Although rare, invasive aspergillosis with intracranial spread usually is fatal and necessitates prompt diagnosis and treatment. We describe the prognoses for survival and vision in 3 consecutive patients with vision-threatening invasive sino-orbital aspergillosis.

Methods: A case series of 3 patients, with review of treatments and outcomes.

Results: Three diabetic patients presented with significant eye pain and headache, followed by progressive ophthalmic symptoms including vision loss and limitation of ocular motility. Histologic examination showed numerous hyphae of Aspergillus fumigatus. Following early diagnosis and surgical debridement, 1 patient (case 1) showed vision improvement, from counting fingers to 20/20. The other 2 patients, who were initially treated with corticosteroids after presumptive diagnoses of nonspecific orbital inflammation, showed no recovery of vision from no light perception, and 1 (case 3) died of massive intracranial spread and side effects of antifungal agents caused by delayed diagnosis and long-term use of corticosteroids.

Conclusions: Invasive sino-orbital aspergillosis with intracranial invasion often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. Repeated biopsies often are necessary to rule out fungal sinus infection before considering steroid use, especially in diabetic patients.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Aspergillosis / diagnostic imaging
  • Aspergillosis / drug therapy
  • Aspergillosis / microbiology*
  • Aspergillus fumigatus / isolation & purification
  • Brain Diseases / diagnostic imaging
  • Brain Diseases / drug therapy
  • Brain Diseases / microbiology*
  • Debridement
  • Eye Infections, Fungal / diagnostic imaging
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / microbiology*
  • Fatal Outcome
  • Female
  • Humans
  • Itraconazole / therapeutic use
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Orbital Diseases / diagnostic imaging
  • Orbital Diseases / drug therapy
  • Orbital Diseases / microbiology*
  • Paranasal Sinus Diseases / diagnostic imaging
  • Paranasal Sinus Diseases / drug therapy
  • Paranasal Sinus Diseases / microbiology*
  • Pyrimidines / therapeutic use
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Triazoles / therapeutic use
  • Voriconazole

Substances

  • Anti-Bacterial Agents
  • Pyrimidines
  • Triazoles
  • Itraconazole
  • Voriconazole