Orbital aspergillosis. Conservative debridement and local amphotericin irrigation.
A patient maintained on long-term immunosuppressive agents after bone marrow transplantation developed an Aspergillus abscess in the right orbit. The abscess was resected without visual compromise and the orbit was irrigated regularly with amphotericin B via an indwelling catheter. Follow-up computed tomography, surgical exploration, and histological analysis demonstrated suppression of fungal growth in the orbit. Persistent fungus was recovered from nonirrigated sinuses despite their previous surgical evacuation and continued systemic amphotericin B administration. Treatment of orbital aspergillosis should include surgical reduction of the local fungal inoculum, supplementation of intravenous antifungal agents with local delivery to minimize systemic toxicity, and attempts to reverse the immunosuppression. If the last is not possible, extensive extirpation of normal surrounding tissues will not prevent repopulation by the ubiquitous fungus.
Harris
G J
GJ
Department of Ophthalmology, Medical College of Wisconsin, Milwaukee.
Will
B R
BR
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000601:surgery*; D016026:Bone Marrow Transplantation; D002408:Catheters, Indwelling; D003646:Debridement; D015521:Ethmoid Sinusitis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007275:Injections, Intravenous; D015470:Leukemia, Myeloid, Acute / Q000601:surgery; D009916:Orbital Diseases / Q000188:drug therapy* / Q000601:surgery*
D000666:Amphotericin B