[Successful treatment of invasive sinus aspergillosis with micafungin and itraconazole].
BACKGROUND
We report a case of invasive sinus aspergillosis that extended to the orbital cavity and cavernous sinus and was improved by treatment with micafungin and itraconazole.


METHODS
A 83-year-old woman was referred to our hospital because of headache and impaired of eye movement on the right side. Physical examination revealed impaired function of cranial nerves, II, II, IV, and VI on the right side. MRI showed evidence of inflammation of the right sphenoid sinus and ethmoidal sinus and an enhancing mass in the right cavernous sinus and orbit. Because a culture of a specimen from the right sphenoid sinus extracted during endoscopic sinus surgery, yielede Aspergillus fumigatus, a diagnosed of invasive sinus aspergillosis complicated by cavernous sinus symdrome and orbital apex symdrome was made. It was difficult to completely remove the mass in the sinuses surgically and drug therapy with micafungin was started and then itraconazole was added. The clinical manifestations and the impaired function of cranial nerves II, III, IV, and VI improved, and MRI showed regression of the mass in the sinuses temporary in response to drug therapy.


CONCLUSIONS
Invasive sinus aspergillosis often progresses rapidly in the absence of surgery. Our case is valuable, because invasive sinus aspergillosis was improved by drug therapy alone, and combined treatment with micafungin and itraconazole was effective.
Okamoto
Masaki
M
Comprehensive Care and Education, Tenri Hospital.
Azuma
Teruhisa
T
Ishimaru
Hiroyasu
H
Abe
Noriyuki
N
Komatsu
Masaru
M
Hatta
Kazuhiro
K
D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000601:surgery; D001232:Aspergillus fumigatus; D002426:Cavernous Sinus / Q000473:pathology; D003131:Combined Modality Therapy; D054714:Echinocandins; D015521:Ethmoid Sinusitis / Q000188:drug therapy; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D055666:Lipopeptides; D008074:Lipoproteins / Q000627:therapeutic use*; D000077551:Micafungin; D009915:Orbit / Q000473:pathology; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D012852:Sinusitis / Q000188:drug therapy*; D015524:Sphenoid Sinusitis / Q000188:drug therapy
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D017964:Itraconazole; D000077551:Micafungin