Sphenocavernous syndrome associated with Schizophyllum commune infection of the sphenoid sinus.
A 47-year-old diabetic man with chronic renal failure presented with a 1-month history of complete ptosis of the left upper eyelid, left proptosis, and left-sided headache. During the course of the patient's care, other significant diagnoses were excluded, such as orbital inflammatory syndrome, carotid-cavernous syndrome, and cavernous sinus thrombosis. Neuroimaging revealed only minimal left sphenoid sinus disease. Sphenoid biopsy revealed the presence of septate hyphae on Gram staining and produced a fungal culture characteristic of Schizophyllum commune. Minimal sphenoid sinus infection in a patient with chronic medical issues and probable immunosuppression predisposed this patient to fungal rhino-orbital infection. Several weeks of intravenous liposomal amphotericin treatment on an outpatient basis yielded resolution of clinical symptoms.
Roh
Michael L
ML
Department of Ophthalmology, The George Washington University, Washington, DC, USA. mroh3@yahoo.com
Tuazon
Carmelita U
CU
Mandler
Raul
R
Kwon-Chung
K J
KJ
Geist
Craig E
CE
D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001706:Biopsy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D012567:Schizophyllum / Q000302:isolation & purification*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000382:microbiology*; D015524:Sphenoid Sinusitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000935:Antifungal Agents; D005938:Glucocorticoids; D000666:Amphotericin B; D008775:Methylprednisolone