Cavernous sinus-orbital apex aspergillus infection in a diabetic patient

Abstract

Rationale: Cavernous sinus-orbital apex aspergillosis is a rare but serious complication of rhinosinusitis. Pathology results are scarce, and this condition is difficult to diagnose based on clinical and radiological results. Patient concerns: A 64-year-old woman presented with cavernous sinus-orbital apex syndrome. Axial and sagittal T1 contrast-enhanced magnetic resonance imaging (MRI) showed a right orbital apex mass abutting the right posterior ethmoid sinus, sphenoid sinus, and cavernous sinus. Diagnosis: Cavernous sinus and orbital apex aspergillosis. Interventions: Functional endoscopic sinus surgery was performed, and a biopsy of the lesion tissue was submitted for examination, which showed the presence of aspergillus. Outcomes: One year after surgical debridement, antifungal, and anticoagulation treatments, the patient is still asymptomatic without recurrence. Lessons: Early surgical debridement is crucial to confirm the diagnosis of cavernous sinus-orbital apex aspergillosis and prevent mortality. There is no evidence of negative effects of antibiotic and anticoagulation treatments. Despite controversy, among physicians, most opt to treat patients via anticoagulation therapy.

A rare infective cause of stroke in an immunocompetent child

“…Early debridement of necrotic tissue, isolation of the causative organism and institution of appropriate antifungal is the most likely cause for successful outcome in a disease which otherwise has high mortality as described in literature. This fact is echoed by all previously reported cases as well [6,[7][8][9][10][11][12].…”

“…All other cases described till date are in middle-aged and elderly adults. Some of the elderly adults had associated diabetes mellitus, but majority of them underwent only HIV serology to rule out associated immunodeficiency states [6,[7][8][9][10][11][12]. In the current case, apart from HIV serology and blood sugar, both quantitative and qualitative tests for T, B and NK cell were performed to rule out commonly inherited causes of immunodeficiency.…”

Fatal Rhinofacial Mycosis Due to Aspergillus nomiae: Case Report and Review of Published Literature

“…Our case showed rhinofacial involvement. Vascular invasion is an important feature of rhino-cerebral mycosis by Mucorales ( Li and Lun, 2012 ; Li et al, 2014 ) and has been observed in rhino-orbital aspergillosis ( Ben-Ami et al, 2009 ; Huang and Gui, 2019 ). Whether or not the lethal cerebral hemorrhage was induced by the angiodestruction of the fungus could not be determined; angioinvasive and angiodestructive characteristics have been observed biopsied in the rhinofacial area.…”

More than Meets the Eye: Aspergillus-Related Orbital Apex Syndrome

“…Management of this should include consultation of an ophthalmologist and an ENT. Repeat imaging and endoscopic nasal surgery to biopsy should follow closely after [1,[4][5]. For uncomplicated infections, Gappy et al recommend that antibiotics should be continued until there is complete resolution: this can range up to at least two to three weeks of IV and PO antibiotic therapy [1].…”