Invasive Rhinosino-orbital Aspergillosis with Precipitous Visual Loss

Mauriello, Joseph A.; Yepez, N.; Mostafavi, Ramin; Barofsky, J.; Kapila, Rajesh; Baredes, Soly; Norris, J.

doi:10.1097/00002341-199712000-00014

Cited by 27 publications

(41 citation statements)

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“…Few recommend orbital exenteration to achieve surgical margins inspite of functional status of the eye [8]. Others recommend vision sparing approach, i.e.,-conservative debridement with antifungal drugs [9,10].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis

Mehta

Panda

Mohindra

et al. 2012

Indian J Otolaryngol Head Neck Surg

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Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis

Mehta

Panda

Mohindra

et al. 2012

Indian J Otolaryngol Head Neck Surg

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“…In AIDS patients, the predisposing factors for orbital infection, especially fungal infections, are immuno-suppressive states which may be diabetes (Lee et al, 1996& Maurriello et al, 1995, diabetic ketoacidosis, intravenous drug abuse, or neutropenia (Evangelo et al, 2006). Notably, the use of protease-inhibitor-based antiretroviral regimes can also precipitate diabetic ketoacidosis (Maurriello et al, 1995& Evangelo et al, 2006, which further aggravates immuno-suppression and opportunistic infections with fungi including rhino-orbital zygomycosis (Lee et al, 1996& Evangelo et al, 2006.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Notably, the use of protease-inhibitor-based antiretroviral regimes can also precipitate diabetic ketoacidosis (Maurriello et al, 1995& Evangelo et al, 2006, which further aggravates immuno-suppression and opportunistic infections with fungi including rhino-orbital zygomycosis (Lee et al, 1996& Evangelo et al, 2006. A state of ketoacidosis in HIV-infected patients can also be induced with the use of pentamidine, which has been seen to cause an increase in the frequency of zygomycosis in HIVinfected patients (Evangelo et al, 2006).…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…The other risk factors for orbital involvement with AIDS include marijuana smoking (Johnson et al, 1999), homosexuality (Johnson et al, 1999), promiscuity (Johnson et al, 1999), alchohol abuse (Maurriello et al, 1995), steroid therapy (Maurriello et al, 1995), advanced age (Maurriello et al, 1995), Epstein Barr virus infection (Suankratay et al, 2005) and intravenous drug abuse (Reifler et al, 1994). The CD4 + cell count in patients with orbital infection has uniformly been found to be low (Johnson, 1999).…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…In cases of sino-orbital aspergillosis, the presenting complaints include fever, headache, nausea, vomiting, decreased vision and pain in the eye (Johnson et al, 1999;Maurriello et al, 1995), though the visual acuity of the involved eye is not very diminished (Johnson et al, 1999). In cases of mass formation, a pressure effect leads Sodhi PK Orbital manifestations in AIDS Nepal J Ophthalmol 2014;6(12): 205-219 to diminution of vision, chemosis, periorbital swelling, axial proptosis (which may be as much as 5 mm), afferent pupillary defect, restriction of ocular motility (Johnson et al, 1999), retroorbital pain, decreased vision (Adler et al, 1997) along with displacement of the globe (Adler et al, 1997) and a swollen optic disc (Johnson et al, 1999).…”

Section: Clinical Featuresmentioning

confidence: 99%

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Orbital manifestations in patients with acquired immunodeficiency syndrome

Sodhi

2014

Nep J Oph

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Introduction: The orbital manifestations of acquired immunodeficiency syndrome (AIDS) are uncommon. Objective: To provide a review of orbital manifestations of AIDS, the predisposing factors, investigations, treatment and outcome. Materials and methods: Meticulous and systematic literature search of Pubmed to identify manuscripts describing orbital manifestations of AIDS was done and the articles were reviewed. The keywords used in the search were "orbit and AIDS", "HIV positive and orbit", "orbit manifestations in AIDS", "orbital disease and AIDS" and "orbital infections and AIDS". The orbital involvement in AIDS may present with opportunistic infections from organisms like fungi, viruses, bacteria and protozoa or with malignancies like Kaposi's sarcoma, squamous cell carcinoma, smooth muscle cell tumors and lymphoma. The predisposing factors for orbital involvement in AIDS are low CD4 + cell count and the immunosuppressive states like diabetes, diabetic ketoacidosis, intravenous drug abuse and neutropenia. A patient may present with fever, headache, nausea, vomiting, decreased vision, ocular pain, and, in cases of mass formation, there is periorbital swelling, axial proptosis, globe displacement and swollen optic disc. Radiologically, mass formation, orbital bony destruction, and spread of disease to contiguous structures including the central nervous system may be seen. The medical management includes therapy for infection and HIV-1 protease inhibitors (highly active antiretroviral therapy) to suppress HIV-1 replication. For tumors, radical surgery including debulking followed by postoperative radiotherapy is generally needed. Conclusion: Orbital involvements with AIDS in any form, infective or malignancy, causes significant morbidity and mortality and should be diagnosed and managed as early as possible.

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Sino-orbital Aspergillosis in Acquired Immunodeficiency Syndrome

Johnson¹,

Casiano²,

Kronish

et al. 1999

Arch Ophthalmol

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To describe the clinical features, causes, imaging characteristics, treatment, and outcome of patients with the acquired immunodeficiency syndrome (AIDS) and sino-orbital aspergillosis.Design: Records of 5 patients were reviewed. Results of imaging and histopathologic examinations and clinical courses of the patients were studied.Results: There were 3 women and 2 men (mean age, 34.0 years). All had received a diagnosis of AIDS, and mean CD4 + cell count was 0.014 ϫ 10 9 /L (14 cells/mm 3 ). Computed tomographic scanning exhibited heterogeneous, enhancing sino-orbital soft tissue lesions with bony erosion, and magnetic resonance imaging disclosed soft tissue masses hypointense on T 1 -and T 2 -weighted images. The infection involved 1 or more paranasal sinuses, with extension into the right orbit in 3 patients and into the left orbit in 2. Patients were treated with aggressive surgical debridement and intravenous antifun-gal agents. In addition, local irrigation of amphotericin B was performed in 3 patients. Aspergillus fumigatus was found to be the cause in all 5 patients. Intracranial extension developed in 4 patients, and all subsequently died. The 2 longest surviving patients were the only ones being treated with protease inhibitors. Three patients had a history of frequent marijuana smoking.Conclusions: Sino-orbital aspergillosis is a progressive, relentless, and usually fatal opportunistic infection of advanced AIDS. Patients are first seen with longstanding headache and proptosis with minimal external inflammatory signs. Marijuana smoking may increase the risk for development of sino-orbital aspergillosis in these patients. Aggressive surgical and medical treatment, combined with newer combination therapies using protease inhibitors, may improve the longevity of these patients.

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Invasive Rhinosino-orbital Aspergillosis with Precipitous Visual Loss

Cited by 27 publications

References 0 publications

Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis

Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis

Orbital manifestations in patients with acquired immunodeficiency syndrome

Sino-orbital Aspergillosis in Acquired Immunodeficiency Syndrome

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