Orbital Aspergillosis: Voriconazole – The New Standard Treatment

Ohlstein, Derek H.; Hooten, Claudia; Pérez, Javier Dubert; Clark, Charles L.; Samy, Hazem

doi:10.1159/000336276

Cited by 17 publications

(17 citation statements)

References 15 publications

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“…Kuga et al 17 were amongst the first to describe the use of voriconazole in a 71-year-old man with invasive sino-orbital aspergillosis with marked improvement. A favourable outcome with voriconazole has also been reported in a few other cases of orbital aspergillosis 7,16,18 . Our patient is undergoing treatment with voriconazle and has responded in that the orbital lesion has stabilised, and clinical symptoms have resolved.…”

Section: Discussionmentioning

confidence: 73%

“…Cases of orbital aspergillosis have been described that were initially misdiagnosed as GCA and treated with corticosteroids. In most such cases, headache and ocular manifestations were the main presenting symptoms and initial imaging of CT or MRI were also normal 2,3,6,7 . In view of the symptomatic improvement in the patient's headache and visual acuity, we continued the use of oral prednisolone despite the TAB being negative for GCA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Orbital Aspergillosis or Giant Cell Arteritis — A Diagnostic Dilemma

Ali

Lui

Salkade

et al. 2013

Proceedings of Singapore Healthcare

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Orbital aspergillosis is an uncommon but potentially fatal disease. Its initial clinical presentation can be nonspecific and may be easily confused with other systemic diseases (such as neoplasms, other orbital infections which could include bacterial, mycobacterium and fungal infections), systemic vasculitis and other inflammatory conditions. Use of systemic corticosteroid may result in transient symptom relief further delaying the diagnosis. We describe its occurrence in a 76-year-old Chinese female with underlying rheumatoid arthritis who presented with a four-week history of left fronto-temporal headache, and ipsilateral blurring of vision with an elevated erythrocyte sedimentation rate (ESR). Although temporal artery biopsy was negative for giant cell arteritis (GCA), high-dose corticosteroids were initially started for presumptive GCA. There was an initial transient improvement in headache and in her left eye's visual acuity. However, this was followed by a worsening headache and complete visual loss in her left eye. Magnetic resonance imaging (MRI) revealed a new orbital apical mass-like lesion extending from the sphenoid sinus which was diagnosed as aspergillus infection on biopsy. Her condition improved and remained stable after the institution of appropriate anti-fungal therapy.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Orbital Aspergillosis or Giant Cell Arteritis — A Diagnostic Dilemma

Ali

Lui

Salkade

et al. 2013

Proceedings of Singapore Healthcare

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“…Many reports show that invasive sino-orbital aspergillosis is found in both immunocompromised and immunocompetent patients. [ 8 – 10 ] Regardless of immune status, sino-orbital aspergillosis can contribute to poor prognosis when treatment is delayed. Most patients present with infiltrative rather than mass patterns of aspergillosis in the orbital region.…”

Section: Discussionmentioning

confidence: 99%

Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

Chang¹,

Chang²,

Chien³

et al. 2018

Medicine

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Rationale:Orbital apex syndrome is a complex clinical disorder featuring a collection of cranial nerve deficits characterized by impairment of the extraocular muscles, the ophthalmic branch of the trigeminal nerve, and even the optic nerve. Sino-orbital aspergillosis is rare but aggressive infection. Surgical resection accompanied by antifungal medication is advised currently.Patient concerns:We report a 61-year-old woman diagnosed as aspergilloma presenting with the characteristic manifestations and imaging features of orbital apex syndrome.Diagnoses:Paranasal sinus tumor was misdiagnosed initially according to magnetic resonance imaging of the orbit. Finally aspergilloma was diagnosed by pathologic report.Interventions:The anti-fungal medication, voriconazole, was administered immediately. Surgical excision was also done due to the poor response to medical treatment.Outcomes:Postoperative follow-up showed no recurrence of aspergillosis but the vision was lost permanently.Lessons:Invasive sino-orbital aspergillosis as an aggressive disease with highly invasive patterns and it may be misdiagnosed as tumors. To achieve better prognosis and survival, clinicians should be aware of this distinct manifestation.

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“…The incidence of invasive aspergillosis in patients with hematologic malignancies has been reported to be as high as 3.1%, with Aspergillus fumigatus representing the most commonly isolated species [ 3 ]. Compared to amphotericin B, voriconazole demonstrates a survival benefit, less systemic toxicity, and better tolerance by patients [ 4 ].…”

Section: To the Editormentioning

confidence: 99%