Invasive aspergillosis of the orbit in immunocompetence

November 26, 2007

Framme C, Rosenfeld J, Sachs HG.Augenklinik und Poliklinik, Universität

Regensburg.

BACKGROUND:

An isolated aspergillosis of the sphenoidal sinus is a difficult

diagnosis because the often misleading clinical symptoms of this rare

disease can develop late and first be presented to the ophthalmologist.

Because of this even life-threatening disease in normally

immunodeficient patients, fast diagnostics and treatment is indicated.

CASE REPORT: We report about an immunocompetent man to suffer from an

invasive aspergillosis involving the sphenoidal sinus after external

operation of a mucocele. Aspergillus infiltrated the right orbit by

bone erosion and led to an acute loss of vision on his right eye and a

pathological visual field (visual acuity 0.1). A systemical antimycotic

therapy was performed and the right orbit and the optical channel were

operated to remove the mycosis. During operation the optical nerve was

found to be completely surrounded by the mycosis. After surgery visual

acuity recovered slowly but completely in about two weeks (visual

acuity 1.0) and visual field examination revealed normal findings.

These findings were stable now for one year. CONCLUSION: The main

findings of unilateral acute visual loss and pre-operations of the

paranasal sinuses in combination with persistent headache can lead to

the suspect of an aspergillosis infection. It is important to establish

correct diagnosis--especially in immunocompetent patients--early to

prevent a probably irreversible visual loss and in an advanced stage to

handle the life-threatening risk of this disease.

PMID: 10827465 [PubMed - indexed for MEDLINE]

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