Orbital apex lesion due to Aspergillosis presenting in Immunocompetent patients without apparent sinus disease

Abstract

We present two cases in which Aspergillus infection was identified at a late stage in the clinical evaluation as the cause for a painful, progressive and indolent orbital apex syndrome in the absence of any clinical or radiological sign of sinus involvement. Surgical investigation was undertaken with serious subsequent morbidity. Although treatment is often satisfactory, neurological outcome is without exception poor. A review of the literature has revealed that the risk of such investigations is high, and advice is provided to readers which may allow avoidance of such complications in the future.

Orbital apex syndrome due to aspergillosis with subsequent fatal subarachnoid hemorrhage

“…[3410] Immunocompromised individuals such as those having acquired immunodeficiency syndrome (AIDS), patients with malignant tumors, diabetes, or on corticosteroids or immunosuppressive agents are at risk of developing aspergillosis. [357911] One of the most lethal but rare sequels of CNS fungal infection is intracranial aneurysm. [1] Mukoyama et al .…”

“…[311] Orbital pain, proptosis, ophthalmoparesis, and optic neuropathy are the possible clinical features. [7911] We report a case of 73-year-old female who got the right side orbital apex syndrome, but finally died of subarachnoid hemorrhage (SAH) probably due to ruptured fungal aneurysm.…”

A Congruous Superior Quadrantanopsia Following a Junctional Scotoma Induced by Asperogillosis

“…If the patient had been treated with high dose steroids aimed at controlling the optic neuritis, the infection could have progressed to fulminant invasive aspergillosis with extension into the orbit and brain, an affliction with an 80% mortality rate [3,6,7]. Therefore, this case illustrates the importance of examining the entire visual system in patients with visual loss in only one eye.…”

Aspergillosis: An Unusual Case of Orbital Apex Syndrome

“…Medical treatment relies on systemic anti-fungals, mainly polyenes (amphotericin B) and azoles (itraconazole, voriconazole), used alone or in combination [2 -6]. The prognosis of aspergillosis is poor, with a high rate of morbidity and mortality [3]. Four years after presentation, our patient still needed a continuous therapy of voriconazole in order to control her aspergillosis but there had been no relapses.…”

“…Aspergillus is an ubiquitous fungus found in hay, grain, soil, dung. In otherwise asymptomatic patients, aspergillus can be frequently found in the paranasal sinuses, which are the usual port of entry [3,4]. Nevertheless, a clinical fungal infection of the orbit is a rare event, occurring mostly in immunocompromized patients [3,4].…”