Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

Abstract

Invasive aspergillosis that involves intra-orbital and intracranial extension occurs in immunodeficient and immunocompetent patients resulting in significant morbidity and mortality. We report the case of a 38year old farmer who had recurrent fronto-ethmoidal mucocoele and proptosis of the left eye. She presented with a history of hypertension and no other significant findings on examination. Computer tomography scan of the brain showed a left fronto-orbital uniform contrast-enhancing extra-axial lesion with thickened peripheral capsule and an associated left fronto-orbital skull defect. Cerebrospinal fluid analysis did not show any sign of infection. Intra-operative biopsy sample showed cheesy material which on culture grew Aspergillus species that was identified further using molecular methods. Antifungal agents were used to treat the patient. The present case strongly suggests that it is possible to control intracranial aspergillosis with a combination of surgery and antifungal chemotherapy.