Invasive orbital aspergillosis in an apparently immunocompetent host without evidence of sinusitis

Abstract

Jennifer Primeggia, George Cyriac, Princy Kumar Invasive aspergillosis is uncommon in healthy individuals. We report a case of Aspergillus fumigatus orbital cellulitis with intracranial extension in an apparently immunocompetent patient with a history of benign lymphoid hyperplasia of the lacrimal gland. A 68 year-old man with no signiicant past medical history underwent orbitotomy and biopsy of a lacrimal gland mass. Pathology showed benign lymphoid hyperplasia of the lacrimal gland and he completed radiation therapy. Three months after orbitotomy and one month after completion of radiation therapy, he presented with orbital cellulitis. Brain magnetic resonance imaging demonstrated invasion into the frontal lobe. Clinical and radiographic indings failed to improve with prolonged antibiotic therapy; transcranial orbitotomy with right frontal craniotomy for abscess drainage and orbit washout was performed. Intraoperative cultures grew Aspergillus fumigatus. The patient completed a six month course of therapy with oral voriconazole and has remained free from relapse with long-term follow-up. Eficacy of voriconazole was guided by serial imaging and voriconazole trough levels. Aspergillus may cause invasive disease in immunocompetent hosts, even without evidence of sinusitis, and should be considered in the dif- ferential diagnosis when patients do not demonstrate clinical improvement with antibiotic therapy.