Invasive Optic Nerve Aspergillosis with Intracranial Extension in an Immunocompetent Patient (P10-10.004)

Abstract

<h3>Objective:</h3> To report on an uncommon case of Invasive Optic Nerve Aspergillosis in an Immunocompetent Patient <h3>Background:</h3> Orbital aspergillosis is an uncommon and life-threatening infection. It often affects immunocompromised individuals but can rarely be seen in immunocompetent patients. We present a case of invasive optic nerve aspergillosis with intracranial extension in an immunocompetent male. <h3>Design/Methods:</h3> Case Report <h3>Results:</h3> 59-year-old man presented with a 6-week history of complete left vision loss and left sided facial pain. He was initially diagnosed with optic neuritis and treated with oral prednisone without resolution of symptoms. Initial work including computed tomography (CT) of the head, magnetic resonance imaging (MRI) of the brain, digital subtraction angiography of the head, fluorescence angiography of the left eye, and temporal artery biopsy were all unremarkable. Optical coherence tomography (OCT) demonstrated mild left optic nerve edema. Due to persistent symptoms, an MRI of the orbits was obtained and revealed left optic nerve diffusion restriction with enhancement along the optic tract, suggesting an abscess. Interval OCT revealed worsening left optic nerve layer thinning. The patient was treated initially treated with ceftriaxone, metronidazole, and vancomycin. The optic nerve abscess was surgically decompressed. Cultures grew Aspergillus fumigatus. He was transitioned to oral isavuconazole for a total of 6 months of antifungal therapy. Repeat head CT one month later revealed skull base osteomyelitis with intracranial extension requiring further surgical debridement. The patient was kept on antifungal therapy. Repeat neuroimaging has been stable but there has been no improvement in his vision. <h3>Conclusions:</h3> Orbital aspergillus is a rare entity and as such is a diagnostic challenge. Multiple surgical debridements in addition to appropriate antifungal therapy may be required as recurrent infections are common. Close interval imaging should be obtained to aid in the initial diagnosis and monitoring of orbital fungal infections. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Whiting has nothing to disclose. Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD serono. The institution of Dr. Malik has received research support from National MS Society .