Abstract
The answer is Aspergillus fumigatus periorbital mass. Upon review of the histopathology, Aspergillus and Fusarium were considered the most likely possible diagnoses. Due to variable susceptibility of Fusarium to azoles, empirical liposomal amphotericin (i.v., 5 mg/kg daily) was started. Formalin-fixed tissue was sent for broad-range fungal PCR (1). MRI 6 days after the start of amphotericin showed minimal change, and symptoms were similar. Further surgical intervention to provide any modicum of source control was not deemed feasible without enucleation of the left eye. Aspergillus fumigatus was detected with 28S, internal transcribed spacer, and nested internal transcribed spacer primer sets. Treatment was transitioned to voriconazole. Periorbital swelling began to improve, and the patient was discharged 13 days after surgery. At that time, his vision, ptosis (inability to open his eye at all), and proptosis were unchanged.
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