Orbital apex syndrome secondary to a fungal nasal septal abscess caused by Scedosporium apiospermum in a patient with uncontrolled diabetes: a case report

Kishimoto, Ippei; Shinohara, Shogo; Ueda, Tetsuhiro; Tani, Satoshi; Yoshimura, Hajime; Imai, Yukihiro

doi:10.1186/s12879-017-2753-6

Cited by 13 publications

(13 citation statements)

References 13 publications

(21 reference statements)

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“…In 2017, Ippei Kishimoto et al reported only the second case of S. apiospermum -related OAS secondary to a fungal nasal septal abscess in a patient with uncontrolled diabetes. In their study, S. apiospermum was detected by the polymerase chain reaction and tissue cultures [10]. Despite treatment with antifungal drugs and surgical resection of the lesion, this patient suffered bilateral vision loss in common with the present case.…”

Section: Discussionmentioning

confidence: 54%

Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Loh

Tai

Hussein

et al. 2018

Cureus

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Orbital apex syndrome (OAS) is a localized orbital cellulitis at the orbital apex that can cause vision loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves. Herein, we report a rare and rapidly progressive case of OAS secondary to fungal pansinusitis caused by Scedosporium apiospermum in an immunocompromised patient following the extraction of abscessed teeth.A 48-year-old man with diabetes mellitus who had failed to adhere to his treatment presented with complaints of a right-sided headache and toothache for two weeks, with nausea and vomiting for two days prior to presentation. The patient was treated for septic shock secondary to the dental abscesses. Non-contrast brain computed tomography (CT) showed no significant intracranial abnormalities other than pansinusitis. Four days later, dental extraction was performed. The patient reported progressive painless blurring of the vision in his right eye following the dental extractions and was referred to the ophthalmology department. Subsequent examinations revealed decreased optic nerve function and ophthalmoplegia in his right eye and dental caries in the upper molars, with a mucopurulent discharge from the right sphenoid region. The clinical diagnosis was OAS. Pus near the orbital apex was drained surgically. Methicillin-resistant Staphylococcus aureus was isolated from the pus and a nasal swab. Tissue culture from the septal wall yielded S. apiospermum. The patient’s condition deteriorated, despite intensive antibiotic and antifungal treatment and repeated surgical debridement. The disease progressed rapidly to his left eye. Sixty-seven days after the inital presentation, his visual acuity (VA) of both eyes was classified as no perception of light (NPL). The patient discharged himself from the hospital (at own risk discharge) and subsequently failed to attend a scheduled appointment in the ophthalmology clinic.If immunocompromised patients present with OAS, fungal infections should be ruled out. Prompt and aggressive treatment using a multidisciplinary approach is mandatory in cases of potentially life-threatening and vision-threatening fungal infections.

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Section: Discussionmentioning

confidence: 54%

Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Loh

Tai

Hussein

et al. 2018

Cureus

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“…It is not possible to find information of Scedosporium infections with neck soft tissue invasion similar to this patient. It is a cause, however of sinusitis and otomycosis [22][23][24][25][26] which makes it unlikely that this fungus is the causal agent in this case.…”

Section: Evolution Of the Patient (Dr Josep Mensa)mentioning

confidence: 87%

Neck infection after allogenic hematopoietic progenitors transplantation

C¹,

Cardozo²,

Fernández³

et al. 2020

Rev Esp Quimioter

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“…OAS related to S. apiospermum has rarely been reported in the literature, each time as non-odontogenic in origin with the exception of the included case. 28,29…”

Section: Discussionmentioning

confidence: 99%

A systematic review of orbital apex syndrome of odontogenic origin: Proposed algorithm for treatment

Leferman

Ciubotaru

Ghiciuc

et al. 2020

European Journal of Ophthalmology

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Orbital apex syndrome (OAS) can be a rare, but severe complication of an odontogenic infection and has high morbidity and mortality. Antibacterial drugs are typically an appropriate treatment choice, but the most severe cases are fungal in nature and pose a tough challenge to the clinician. The aim of this study was to determine the predisposing factors, specific aspects in its management and the appropriate treatment strategy in order to improve patient outcome. A systematic review was conducted using PubMed, PubMed Central, Web of Science, and Scopus up to February 2020, based on the associations between dental extraction or infections and OAS. Of 721 papers found, 18 articles were considered eligible and presented in total 21 cases (13 fungal and eight bacterial infections). The information was organized into a diagnostic and treatment algorithm which included data extracted both from the included cases and updated literature of treatment efficacy studies. Immunosuppression (uncontrolled diabetes mellitus and chemotherapy) was found as an important predisposing factor particularly for fungal infections. In these cases, we suggest that early simultaneous approaches, including aggressive surgical procedures and systemic administration of amphotericin B, result in a better outcome. In conclusion, medical intervention success depends on aggressive treatment and multidisciplinary teamwork.

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Orbital apex syndrome secondary to a fungal nasal septal abscess caused by Scedosporium apiospermum in a patient with uncontrolled diabetes: a case report

Cited by 13 publications

References 13 publications

Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Neck infection after allogenic hematopoietic progenitors transplantation

A systematic review of orbital apex syndrome of odontogenic origin: Proposed algorithm for treatment

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