Outcomes of three patients with intracranially invasive sino-orbital aspergillosis.
OBJECTIVE
Although rare, invasive aspergillosis with intracranial spread usually is fatal and necessitates prompt diagnosis and treatment. We describe the prognoses for survival and vision in 3 consecutive patients with vision-threatening invasive sino-orbital aspergillosis.


METHODS
A case series of 3 patients, with review of treatments and outcomes.


RESULTS
Three diabetic patients presented with significant eye pain and headache, followed by progressive ophthalmic symptoms including vision loss and limitation of ocular motility. Histologic examination showed numerous hyphae of Aspergillus fumigatus. Following early diagnosis and surgical debridement, 1 patient (case 1) showed vision improvement, from counting fingers to 20/20. The other 2 patients, who were initially treated with corticosteroids after presumptive diagnoses of nonspecific orbital inflammation, showed no recovery of vision from no light perception, and 1 (case 3) died of massive intracranial spread and side effects of antifungal agents caused by delayed diagnosis and long-term use of corticosteroids.


CONCLUSIONS
Invasive sino-orbital aspergillosis with intracranial invasion often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. Repeated biopsies often are necessary to rule out fungal sinus infection before considering steroid use, especially in diabetic patients.
Yoon
Jin Sook
JS
Department of Ophthalmology (The Institute of Vision Research), Yonsei University College of Medicine, Seoul, Korea.
Park
Hyung Kyu
HK
Cho
Nam Hoon
NH
Lee
Sang Yeul
SY
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D003646:Debridement; D015821:Eye Infections, Fungal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D011743:Pyrimidines / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000900:Anti-Bacterial Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D065819:Voriconazole