Oribital apex syndrome caused by aspergilloma in an immunocompromised patient with cutaneous lymphoma: A case report of a rare entity

Abstract

A 57yearold man with a history of chemotherapy because of cutaneous lymphoma presented with an orbital apex syndrome. The cranial computed tomography scan revealed a tumour in the orbital apex, extending intradurally. With a suspected diagnosis of a neoplastic lesion, the patient underwent orbital surgery with optic nerve decompression. Histology revealed an aspergilloma. No other foci were seen and treatment with antifungals was started. In immunocompromised patients with intracranial tumours, infection is always a major consideration in the differential diagnosis, even if the reason for immunosuppression (in this case chemotherapy) dates back several months. Misdiagnosing an orbital apex lesion as a cancer and treating patients primarily with corticosteroids can be life threatening. Removal or biopsy of such lesions is essential in further treatment since antifungals have to be administered as fast as possible.

Cavernous sinus-orbital apex aspergillus infection in a diabetic patient

“…This type of infection is often found in immunocompromised patients with type 2 diabetes mellitus, long-term corticosteroid use, hematologic malignancy or HIV infection. [3,4] Some case reports indicate that aspergillosis is misdiagnosed as tumor metastasis, [5,6] which delays treatment. However, aspergillus infections rarely invade both the cavernous sinus and orbital apex.…”

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

“…The clinical characteristics and demographics of these 5 patients and our patient are listed in Table 1 . [ 6 , 11 – 14 ] Of the 6 patients, 4 were immunocompromised and 2 were immunocompetent. The ages of these patients ranged from 43 to 65 years (immunocompromised patients: 52–64 years; immunocompetent patients: 43–65 years).…”

“…It can mimic orbital pseudotumor and as tumor metastasis in patient with a history of malignancy. [ 6 ] Having presented as a necrotic mass covering the entire bulbar surface, it was misdiagnosed as an orbital surface squamous neoplasia [ 13 ] in a HIV patient.…”

“…[ 5 ] Some case reports revealed the misdiagnosis of aspergilloma as tumor metastasis due to patient's history of malignancy. [ 6 , 7 ] This delayed treatment. However, aspergilloma complicated by OAS has been rarely addressed.…”

An interesting localization of fungus ball: Paratracheal aspergilloma.

“…[6][7][8] Orbital aspergilloma has been cited as a result of paranasal sinus involvement or direct contact. [9] Cases of cardiac aspergilloma have also been observed in patients who underwent cardiac surgery, and those with a history of intravenous drug dependency or parenteral nutrition.…”