A case of orbital apex syndrome caused by invasive aspergillosis successfully treated during the diagnostic procedure by the use of voriconazole

Abstract

F i g . 1 Ax i a l T1 we i g h t e d b r a i n MR I i ma g e t a k e n b e f o r e t r e a t me n t s h o ws i s o -i n t e n s e l e s i o n i n t h e l e f t o r b i t a l a p e x a n d s p h e n o i d i t i s ( A) , b u t o n T2 we i g h t e d i ma g e t h e l e f t o r b i t a l a p e x l e s i o n i s i n a pp a r e n t ( B ) . C o r o n a l T1 we i g h t e d i ma g e wi t h G d -DTPA e n h a n c e me n t s h o ws t h i c k e n e d d u r a ma t e r o f t h e c e r e b r u m a n d c e r e b r a l f a l x ( C , D) . ( TOS HI B A VI S ART 1 . 5 T, A, C , D: TR＝ 5 2 0 , TE＝ 1 5 , B : TR＝ 4 , 6 0 0 , TE＝ 1 2 0 ) F i g . 2 Ax i a l T1 we i g h t e d i ma g e t a k e n 4 2 d a y s a f t e r t r e a t me n t ( A) , a n d T2 we i g h t e d i ma g e ( B ) s h o w d e c r e a s e d l e s i o n i n t h e l e f t o r b i t a l a p e x a n d i

Superior orbital fissure syndrome caused by aspergillus infection from maxillary sinusitis

“…Focal infection is sometimes not reflected in the blood tests and culture studies. Thoughtless use of corticosteroids can worsen the patient's prognosis . In the present case, we could not obtain clear proof of fungal infection based on blood, CSF tests and cultures; however, sinusitis with calcification led us to the correct treatment …”

“…Thoughtless use of corticosteroids can worsen the patient's prognosis. 4 In the present case, we could not obtain clear proof of fungal infection based on blood, CSF tests and cultures; however, sinusitis with calcification led us to the correct treatment. 1 Many cases of orbital apex syndrome associated with paranasal sinus aspergillosis; for example, the sphenoid and ethmoid sinuses, have been reported.…”

Orbital Aspergillosis: Voriconazole – The New Standard Treatment

“…Voriconazole 6 mg/kg for 1 day, then 4 mg/kg/day, has less systemic side effects than amphotericin B, favorable bone penetration, and is better tolerated for maintenance therapy [10, 11, 12]. Despite its favorable profile, we could only find one case report in the English literature and two abstracts in the Japanese literature on voriconazole treatment of invasive orbital aspergillosis [10, 13, 14]. In each of these case reports, the patients demonstrated a dramatic improvement within several days of voriconazole therapy.…”

“…for 12 months. The Japanese literature presented 2 cases of patients in their 70s being successfully treated for orbital aspergillosis, but the treatment protocols were not discussed in the abstracts [13, 14]. …”

An Update on Voriconazole in Ophthalmology

“…44 Two more case reports from Japanese literature have revealed successful treatment of orbital apex syndrome caused by invasive orbital aspergillosis with voriconazole. 45,46 7. Fungal Subretinal abscess Sub retinal abscesses are a rare occurrence.…”