A Rare Case of Sino-Orbital Invasive Aspergillosis in a Kidney Transplant Recipient

Adela D Mattiazzi,Efrat Saraf Lavi,Giselle Guerra,Jose F Camargo,Camilo A Cortesi,Warren L Kupin

doi:10.31487/j.tcr.2020.01.04

Abstract

Invasive sino-orbital aspergillosis is an uncommon but potentially life-threating complication of kidney transplantation. Here we report a case of a patient with invasive aspergillus fumigatus sinusitis extending into the orbit in a kidney transplant recipient who was successfully treated with voriconazole and surgical debridement without requiring orbital exenteration. This case illustrates a rare but life-threatening complication of immunosuppression that highlights the importance of suspecting and promptly recognizing fungal infection of the sinuses in vulnerable organ transplant recipients in order to avoid significant morbidity and mortality.

Highlights

Sino-orbital aspergillosis is a rare disorder that results when infection of the paranasal sinuses spreads into the orbit. This form of invasive aspergillosis may present as localized disease, which spreads to adjacent structures, or as a fulminant systemic disease
We describe a case of invasive Aspergillus fumigatus sinusitis extending into the orbit in a kidney transplant recipient who was successfully treated with voriconazole and surgical debridement
Solid organ transplant (SOT) recipients require long term use of immunosuppressive medications that place them at risk for opportunistic infections

Summary

Introduction

Sino-orbital aspergillosis is a rare disorder that results when infection of the paranasal sinuses spreads into the orbit. A 70-year-old Caucasian male, with past medical history significant for end stage renal disease secondary to focal segmental glomerulosclerosis status post pediatric en bloc kidney transplant, presented with nasal congestion, sinus pain and general malaise six months after transplant He was on maintenance immunosuppression therapy with tacrolimus, mycophenolate mofetil, and prednisone. Orbital and brain MRI showed enhancing soft tissue in the orbital floor involving the lateral, medial and inferior rectus muscles and postsurgical changes without intracranial involvement (Figure 2B) Four days later he underwent further debridement of the pterygoid muscles with resection of the maxillary nerve up to the foramen rotundum. The patient developed Cytomegalovirus (CMV) viremia two months after discharge for which he was treated with valganciclovir until complete resolution His kidney function remained stable with a serum creatinine of 0.5 mg/dl while on maintenance immunosuppression with tacrolimus and prednisone. He sustained complete resolution of initial persistent chronic facial neuropathic pain after one year of the initial presentation

Discussion

Conclusion

Findings

Conflicts of Interest