ABSTRACT
PURPOSE: To report a case of cerebral aspergillosis with third, fourth, and sixth nerve palsy. CASE SUMMARY: A 66-year-old female presented with ocular pain, diplopia, ptosis, and limited ocular movement of the right eye. The patient had experienced rhinorrhea and headache in the right temporal area 3 weeks prior and was treated with oral antibiotics for 1 week. Marginal reflex distance 1 was -4 mm in the right eye and +4 mm in the left eye. Upward, downward, medial, and lateral gaze limitation (-4/-4/-3.5/-2.5) was evaluated. Magnetic resonance imaging (MRI) revealed a mass originating from the nasopharynx and passing through the petrous apex, foramen lacerum, carvernous sinus, sphenoid sinus, orbital apex, and inferior orbital fissure. The mass had high signals on T2-weighted imaging. After 5 days, the mass was removed by endoscopic surgery and aspergillus was detected histopathologically. The patient was given intravenous voriconazole for 11 days and oral voriconazole for 11 weeks. Ptosis and ocular movement limitation began to improve after 6 weeks postoperatively. After 4 months, ocular movement was not limited and there was no recurrence during the 1 year follow-up period. CONCLUSIONS: The present case showed that orbital aspergillosis can invade the intracranial area and third, fourth, and sixth nerve palsy can develop without exophthalmos. Thus, when ocular movement disorders, ptosis and symptoms of sinusitis are present in orbital aspergillosis patients, use of appropriate diagnostic tools such as MRI and active treatment are important.
Subject(s)
Aged , Female , Humans , Abducens Nerve Diseases , Anti-Bacterial Agents , Aspergillosis , Aspergillus , Diplopia , Exophthalmos , Follow-Up Studies , Headache , Magnetic Resonance Imaging , Movement Disorders , Nasopharynx , Orbit , Recurrence , Reflex , Sinusitis , Sphenoid SinusABSTRACT
PURPOSE: To report a case of orbital aspergillosis with third nerve palsy. CASE SUMMARY: A 75-year-old male presented with abrupt onset of visual impairment, extraocular movement limitation, and ptosis. The patient previously experienced rhinolalia and headache and was diagnosed with sinusitis 2 months prior, and was treated with oral antibiotics for 1 week. Orbital magnetic resonance imaging revealed a mass with bone erosion including the nasal cavity, ethmoid bone, and left orbit suggestive of fugal sinusitis. Aspergillus was detected histopathologically in the mass which was removed by endoscopic surgery. Amphotericin B was administered intravenously for 7 days along with voriconazole. There was no recurrence during the follow-up period. Extraocular movement limitations and ptosis were recovered postoperatively. CONCLUSIONS: The present study results indicate that visual impairment and third nerve palsy can develop in a patient with orbital aspergillosis.
Subject(s)
Aged , Humans , Male , Amphotericin B , Anti-Bacterial Agents , Aspergillosis , Aspergillus , Ethmoid Bone , Follow-Up Studies , Headache , Magnetic Resonance Imaging , Nasal Cavity , Oculomotor Nerve Diseases , Orbit , Recurrence , Sinusitis , Speech Disorders , Vision DisordersABSTRACT
Aspergillus is also a saprophytic, ubiquitous fungus that is normally not pathogenic in humans. When it does appear as a source of infection, the rhinoorbital route of entry seemes to parallel that of the Phacomycetes. We experienced a case of orbital aspergillosis in healthy woman. There was no intracraneal extension. In spite of local infiltration of amphotericin B solution through maxillary sinus and aggressive systemic amphotericin B therapy, ocular symptom and sign was not improved. So we performed orbital exenteration and adjunctive amphotericin B and itraconazol systemically. Six months later the patient is alive without recurrence. We reviewed the available literatures regarding this uncommon disease.