Invasive Sino-orbital Aspergillosis Research Articles

Invasive Sinu-Naso-Orbital Aspergilloma Following Dacryocystorhinostomy in an Immunocompetent Patient: A Rare Case Report and Literature Review

Background: Invasive sinu-naso-orbital aspergilloma is a rare disease with variable clinical features, but in an immunocompetent patient, it is rarely considered and often resulted in a poor prognosis due to its diagnostic and therapeutic challenges. In this article, we report a rare case of invasive sinu-naso-orbital aspergillosis with intracranial extension following dacryocystorhinostomy. To the best of our knowledge, this is the only reported case in the past 109 years. Case Description: A 61-year-old normotensive nondiabetic male was referred to us from an ophthalmologist with complaints of retro-orbital pain followed by progressive dimness of vision and later blindness on right eye after dacryocystorhinostomy. Diagnosis and Intervention: His MRI reveals an isointense lesion in the T1W and T2W images in the right maxillary, ethmoidal sinus with orbital and retro-orbital, and intracranial extension with heterogeneous contrast enhancement. A radiologist suggested a case of inflammatory pseudotumor, and initially he was treated with steroids due to a lack of clinical response; later, antifungal was given, but the patient still was nonresponsive. A right pterional craniotomy was performed on the patient to access the optic nerve and perform the biopsy. Aspergillus infection was seen by histopathology. Postoperatively, he was treated with voriconazole. Lessons: In immunocompetent individuals, invasive sino-orbital aspergillosis is uncommon. For effective care, early diagnosis is essential. Our advice is that a patient with vague symptoms or retro-orbital discomfort should encourage the doctor to investigate this diagnosis due to the diagnostic difficulties and greater mortality and morbidity rates.

Invasive Sinu-Naso-Orbital Aspergilloma Following Dacryocystorhinostomy in an Immunocompetent Patient: A Rare Case Report and Literature Review

Background: Invasive sinu-naso-orbital aspergilloma is a rare disease with variable clinical features, but in an immunocompetent patient, it is rarely considered and often resulted in a poor prognosis due to its diagnostic and therapeutic challenges. In this article, we report a rare case of invasive sinu-naso-orbital aspergillosis with intracranial extension following dacryocystorhinostomy. To the best of our knowledge, this is the only reported case in the past 109 years. Case Description: A 61-year-old normotensive nondiabetic male was referred to us from an ophthalmologist with complaints of retro-orbital pain followed by progressive dimness of vision and later blindness on right eye after dacryocystorhinostomy. Diagnosis and Intervention: His MRI reveals an isointense lesion in the T1W and T2W images in the right maxillary, ethmoidal sinus with orbital and retro-orbital, and intracranial extension with heterogeneous contrast enhancement. A radiologist suggested a case of inflammatory pseudotumor, and initially he was treated with steroids due to a lack of clinical response; later, antifungal was given, but the patient still was nonresponsive. A right pterional craniotomy was performed on the patient to access the optic nerve and perform the biopsy. Aspergillus infection was seen by histopathology. Postoperatively, he was treated with voriconazole. Lessons: In immunocompetent individuals, invasive sino-orbital aspergillosis is uncommon. For effective care, early diagnosis is essential. Our advice is that a patient with vague symptoms or retro-orbital discomfort should encourage the doctor to investigate this diagnosis due to the diagnostic difficulties and greater mortality and morbidity rates. Abbreviations: DCR: dacryocystorhinostomy, PL: Perception of light, PR: Projection of rays

A Rare Case of Sino-Orbital Invasive Aspergillosis in a Kidney Transplant Recipient

Invasive sino-orbital aspergillosis is an uncommon but potentially life-threating complication of kidney transplantation. Here we report a case of a patient with invasive aspergillus fumigatus sinusitis extending into the orbit in a kidney transplant recipient who was successfully treated with voriconazole and surgical debridement without requiring orbital exenteration. This case illustrates a rare but life-threatening complication of immunosuppression that highlights the importance of suspecting and promptly recognizing fungal infection of the sinuses in vulnerable organ transplant recipients in order to avoid significant morbidity and mortality.

A case of cerebral infarction due to invasive sino-orbital aspergillosis

A case of cerebral infarction due to invasive sino-orbital aspergillosis

Seven cases of localized invasive sino-orbital aspergillosis

To describe the clinical manifestations and prognoses in 7 patients with invasive sino-orbital aspergillosis (ISOA). This was a retrospective study of consecutive patients who were diagnosed as having ISOA at the Gifu University Hospital and Gifu Municipal Hospital between January 1993 and December 2015. Data were collected on demographics, initial manifestations, examination findings, treatments, clinical course, and outcomes. The median age of the 7 patients with ISOA was 68years; 5 of them had diabetes. The initial symptoms were reduced blurred vision (57%), unilateral headaches (43%), unilateral abnormal sensations or numbness of the periorbital area (43%), and external ophthalmoplegia (43%). The medical department that the patients first visited was the ophthalmology department in 57% of the cases. The initial CT showed bone destruction in 71% and calcification in 14% of the patients. Six of the 7 cases were misdiagnosed. The definitive diagnosis of ISOA was made by histopathologic examinations of the biopsy specimens, with an average of 2.6 biopsies. All patients received aggressive antifungal treatments after the diagnosis. However, the final visual outcome was no light perception in 86% and death related to the ISOA in 43% of the patients. Patients who were older at the onset had lower survival rates. The prognosis for patients with ISOA is poor in terms of both vision and life. Ophthalmologists are often the first examiner. ISOA should be considered in the differential diagnosis for patients with a gradually progressive orbital mass, unilateral headaches, numbness of the periorbital area, and a decrease in visual acuity of unknown origin.

Invasive Aspergillosis in an Immunocompetent Asian Teenager

Purpose: To report a case of invasive Sino-orbital aspergillosis in an Immunocompetent Asian teenager Method: Case Report Result: An immunocompetent Asian teenager with no comorbidities presented with a unilateral orbital proptosis with orbital cellulitis-like symptoms was unresponsive to medical therapy. Findings on computed tomography demonstrated a fairly homogenous mass occupying the entire left maxillary sinus, with erosion of the orbital floor and medial wall to invade the ethmoids and the orbit. Excision biopsy of the mass showed fungal elements with tissue invasion and granulomatous reactions. Treatment included excision of the mass and systemic antifungals. During the course of treatment, however, the patient lost vision on the affected eye, which did not improve even after excision of mass and treatment of the infection Conclusion: Clinicians should be aware of the possibility of having a fungal infection mimicking other infections and tumors in immunocompetent host since prompt treatment could possibly save the vision, and, in the long run, the patient’s life.

Use of Mesenchymal Cells to Modulate Immune Suppression and Immune Reconstruction in a Patient with Aplastic Anemia Complicated by Invasive Sino-Orbital Aspergillosis

Cultured human bone marrow mesenchymal cells (MSCs) have immunomodulatory and tissue regenerative properties. This report summarizes the result of post-transplant treatment with MSCs of a 26-year-old patient with aplastic anemia complicated by invasive sino-orbital aspergillosis. The patient was treated with MSCs to benefit from the dual effects of MSCs in immune reconstitution: suppression against alloreactive T cells and facilitation of the re-engraftment process. The patient did not develop acute or chronic graft-versus-host disease. The aspergillus infection healed completely. The engraftment failure was also ended without any complications. During his last visit in his fourth year after transplantation, the patient was in hematological remission. Human bone marrow-derived MSCs seem to have an important role in preventing or overcoming immunological complications in patients who undergo stem cell transplantation.

Invasive Aspergillosis as the Presenting Manifestation of Small-Cell Carcinoma

Invasive aspergillosisusually occurs in immunocompromised patients, particularly in patients with hematological malignancies because of severe and prolonged neutropenia and/orcytotoxic therapy. Therapy requires antifungal chemotherapy, with lipid-formulations of Amphotericin B or with azoles together with wide surgical excision of the fungal lesion. We report a case of invasive sino-orbital aspergillosis due to Aspergillus fumigatus in a patient with uncontrolled diabetes mellitus and small cell carcinoma. We support the notion that dual immunosuppression due to diabetes and small cell carcinoma with liver metastases was responsible for the invasive form of aspergillosis in this patient.

Invasive Sino-orbital Aspergillosis in an Immunocompetent Host selecting a Surgical Approach: Changing Trend

ABSTRACT Invasive aspergillosis in an immunocompetent host is a rare clinical entity. The purpose of this article is to create awareness of existence of invasive sino-orbital aspergillosis in an immunocompetent, young, otherwise healthy host and its management with emphasizing the importance of balancing open surgical approach with endoscopic approach in order to achieve the optimum clearance of disease. A 48 years old female patient presented with 6 months history of nontender swelling over the left maxilla, 5 months history of left-sided nasal blockage and 2 months history of left orbital proptosis. How to cite this article Kulkarni AS, Karnik P, Nataraj U. Invasive Sino-orbital Aspergillosis in an Immunocompetent Host selecting a Surgical Approach: Changing Trend. Clin Rhinol An Int J 2013;6(2):100-105.

Invasive Aspergillosis of Orbit in Immunocompetent Patients: Treatment and Outcome

Invasive sino-orbital aspergillosis in immunocompetent patients is a rare clinical entity and often misdiagnosed. Invasive sino-orbital aspergillosis is potentially fatal; however, mortality may be avoided with timely treatment. Presently, there are no universal guidelines for its treatment. We present the clinical features, treatment, and outcome in 15 cases of invasive sino-orbital/orbital aspergillosis in healthy individuals. Retrospective case series. Fifteen cases of invasive sino-orbital/orbital aspergillosis in immunocompetent individuals. We retrospectively analyzed all patients with sino-orbital/orbital aspergillosis who were treated at the Dr. Rajendra Prasad Center for Ophthalmic Sciences between June 1999 and September 2009. Diagnosis was based on histopathologic documentation of tissue invasion by septate fungal hyphae with acute angle branching and presence of granulomatous inflammation. Treatment outcome in terms of patient survival, resolution of symptoms, and resolution of orbital mass on imaging. Fifteen patients (11 male and 4 female) were studied. Mean age of patients was 35 years. One patient declined treatment. Surgery was performed for orbital disease in 6 patients. Medical therapy consisted of intravenous amphotericin B followed by itraconazole in 10 patients, itraconazole alone in 2 patients, and voriconazole followed by itraconazole in 2 patients. Eleven patients are alive without recurrence at a median follow-up of 20 months. Of these patients, 5 had residual mass on imaging at last follow-up. One patient died of progressive disease. This is a large case series of orbital aspergillosis reported in healthy individuals. The role of orbital surgery is not clear in treatment of this entity and requires further evaluation. Newer antifungal agents alone seem to be effective in controlling the infection.

Rhino-orbital Aspergillosis: Changing Trends in the Management?

Abstract Purpose To analyze the results of oral voriconazole following optimum management protocol for invasive sino-orbital aspergillosis. Methods It was a prospective study wherein all immunocompetent cases with a final histopathological diagnosis of invasive sino-orbital aspergillosis were included from a period between Jan 2007 till Dec 2009. All cases were evaluated clinically and radiologically for the condition and were classified into four groups on clinical and radiological basis. All cases were subjected to endonasal endoscopic biopsy and were subjected as per the optimum management protocol. These were then followed up for a period ranging from 6 months to 3 years clinically, endoscopically and radiologically. Results There were 15 cases enrolled for the study. There were 10 males and 5 females with age ranging from 14 to 43 years. The most common sign was proptosis. The cases in each group were subjected to the treatment protocol decided for the group. Residual disease was seen in 2 cases (13.34%) and recurrence was seen in 1 case (6.67%). One patient (6.67%) died of disease in our series. Conclusion Invasive sino-orbital aspergillosis is associated with significant morbidity and mortality. In our study, voriconazole was found to drastically improve the outcome of sino-orbital aspergillosis.

Postgraduate institute management protocol for invasive Aspergillus flavus sinusitis: is it effective?

To analyze the results of a postgraduate institute management protocol for invasive Aspergillus flavus sinusitis. This was a prospective study wherein all patients with a final histopathological diagnosis of invasive sino-orbital aspergillosis were included for the period between January 1998 and December 2005. All the patients were negative for HIV, diabetes, and chronic granulomatous disease. All patients were evaluated clinically, biochemically, and radiologically for the condition, and were classified into four groups on the basis of clinical and radiological findings. All patients were subjected to endonasal endoscopic biopsy and were subjected as per the management protocol. These patients were then followed up clinically, endoscopically, and radiologically for a period ranging from 9 months to 7 years. A total of 74 patients were enrolled in the study, 52 males and 22 females, ranging in age from 26 to 53 years. The most common sign was proptosis. The patients in each group were subjected to the treatment protocol decided for the group. Overall, residual disease was seen in 14 patients (18.9%) and recurrence was seen in six patients (8.1%). Twenty-four (32.4%) patients died of the disease in our series. Residual disease and recurrent disease were seen more often in the advanced cases. Invasive sino-orbital aspergillosis is associated with significant mortality. By following our management protocol we were able to reduce the mortality to 32.4% in our series.

Clinical significance of (1→3)-β- d-glucan in a patient with invasive sino-orbital aspergillosis

Objectives The usefulness of BG as a marker has been reported in patients with pulmonary aspergillosis. However, no data have demonstrated the behavior of BG in sino-orbital IA. We encountered a case of sino-orbital IA and demonstrated changes in the BG level, radiological images, and pathological features. Method and results A 63-year-old Japanese woman suffered from invasive sino-orbital aspergillosis. The serum BG level measured immediately before surgery was 37.2 pg/mL (normal value <3.4 pg/mL). Endoscopic sinus surgery revealed some necrotic tissue extending from the ethmoid sinus to the orbit. The infiltrating Aspergillus was revealed in the pathological examination. The BG level decreased to the normal value. However, CT revealed a high-density area; this may indicate that an aspergillosis lesion remained slightly in the orbit. Conclusion (1→3)-β- d-Glucan (BG) is a useful marker for diagnosing Aspergillus and evaluating the therapeutic effect of the treatment administered.

Outcomes of Three Patients With Intracranially Invasive Sino-orbital Aspergillosis

Although rare, invasive aspergillosis with intracranial spread usually is fatal and necessitates prompt diagnosis and treatment. We describe the prognoses for survival and vision in 3 consecutive patients with vision-threatening invasive sino-orbital aspergillosis. A case series of 3 patients, with review of treatments and outcomes. Three diabetic patients presented with significant eye pain and headache, followed by progressive ophthalmic symptoms including vision loss and limitation of ocular motility. Histologic examination showed numerous hyphae of Aspergillus fumigatus. Following early diagnosis and surgical debridement, 1 patient (case 1) showed vision improvement, from counting fingers to 20/20. The other 2 patients, who were initially treated with corticosteroids after presumptive diagnoses of nonspecific orbital inflammation, showed no recovery of vision from no light perception, and 1 (case 3) died of massive intracranial spread and side effects of antifungal agents caused by delayed diagnosis and long-term use of corticosteroids. Invasive sino-orbital aspergillosis with intracranial invasion often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. Repeated biopsies often are necessary to rule out fungal sinus infection before considering steroid use, especially in diabetic patients.

Sudden Painless Visual Loss

Common signs and symptoms of temporal arteritis include headache, scalp tenderness, jaw claudication, anemia, and an elevated sedimentation rate (ESR). Severe complications can include blindness, retinal artery occlusion, and optic neuropathy. While temporal arteritis may be suggested by patient history, other causes that can mimic its presentation must be considered, especially when visual loss occurs in the setting of a normal funduscopic exam. We report a case of invasive sino-orbital aspergillosis that mimicked the clinical signs and symptoms typically associated with temporal arteritis. A high index of suspicion and appropriate radiological and laboratory studies prevented delays in formulating the correct diagnosis and treatment plan.