Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient.

PURPOSE: Invasive Fungal Sinusitis (IFS) is a potentially life-threatening condition that can progress rapidly to the orbit and the brain, especially if it goes on undetected for a long period. We report a case of a 28-year-old pregnant woman in her second trimester with sino-orbital A spergillosis and subsequent brain involvement who tragically developed deterioration of her neurological status and a spontaneous abortion. OBSERVATIONS: The patient presented to the ophthalmology emergency department, King Khaled Eye Specialist Hospital, Riyadh, complaining of left upper eyelid fullness with a palpable eyelid mass and chronic relapsing remitting dull pain for 4 months. Clinical examination was significant for reduced colour vision in the left eye, limited left supraduction, left upper eyelid firm palpable mass, inferior dystopia and proptosis of 4 mm. Magnetic Resonance Imaging (MRI) done without contrast-enhancement due to her pregnancy revealed aggressive infiltrative sinonasal, nasal septum, cribriform plate, orbital, intracranial infiltration with extensive brain edema and midline falcine herniation patterns. Endoscopic endonasal biopsy of the lesions showed septate hyphae branching at acute angles, suggestive of A spergillosis. Her neurological status deteriorated with a spontaneous abortion during admission. CONCLUSIONS AND IMPORTANCE: This case demonstrates that IFS could present only with proptosis, eyelid fullness, chronic pain without external inflammatory signs and should be considered in such presentation even in immunocompetent patients. Early detection and management are crucial. Whether pregnancy presents a relative immune susceptibility to IFS is an issue that needs further in-depth investigation.

Eyelid molluscum contagiosum presenting as a giant solitary ulcerating mass.

Molluscum contagiosum is a benign viral cutaneous infection. It typically presents as an asymptomatic centrally umbilicated nodule 3-5 mm in diameter. Susceptible patients are children and adults receiving immunosuppressive therapy. We report a case of an eyelid molluscum contagiosum in a 5-year-old boy with no risk factors and a 2-week history of a large localized ulcerating mass of the left upper eyelid. The mass was totally excised, and diagnosis of molluscum contagiosum was confirmed in the histopathology study. Microscopic examination revealed enlarged keratinocytes, and acquired eosinophilic Henderson-Patterson inclusion bodies were also detected. Such ulcerating solitary lesions can be misdiagnosed as infected epidermal cysts, keratoacanthoma, or infected chalazions; therefore, molluscum contagiosum should be considered in the differential diagnosis. Complete excisional biopsy of the mass is diagnostic and curative.