Progressive Vision Loss of a Deployed Soldier with Paranasal Sinus Mass

Abstract

Objective: Understand the causes of progressive vision loss of a deployed soldier with paranasal sinus mass. Evaluate effectiveness of a multidisciplinary treatment team on the patient’s disease morbidity. Method: Case report of a soldier deployed to Iraq who developed allergic fungal sinusitis and presented with compressive optic neuritis. He was treated with high dose steroids and functional endoscopic sinus surgery with recurrent bilateral optic neuritis two weeks after surgery. Results: The patient was found to have allergic fungal sinusitis of a pneumatized clivus with a dehiscent optic nerve. He originally had excellent recovery of his vision after FESS. While recovering at home he had a subsequent relapse in both eyes 2 weeks later. Repeat imaging and exam in the operating room did not show a recurrence of the fungal debris. A multidisciplinary team involving ophthalmology, neurosurgery, and infectious disease subsequently found false positive Lyme titers with positive serology for syphilis in conjunction with his infectious optic neuritis. Conclusion: Vision loss from optic neuritis can be caused by sinusitis of the sphenoid such as with allergic fungal sinusitis, but other diagnoses and a multidisciplinary team must be pursued if initial treatment does not result in sustained or expected improvement.