Syphilis and the monk.
Primary orbital aspergillus infection may occur in immunocompetent individuals. It frequently represents a diagnostic challenge for clinicians due to nonspecific clinical presentations and neuroimaging signs. We present a 47-year-old otherwise healthy man with an isolated unilateral optic neuropathy secondary to primary orbital aspergillosis. He had a remote history of tuberculosis and positive syphilis serologies. After he worsened despite intravenous penicillin therapy, a biopsy showed chronic inflammation. Corticosteroids treatment was followed by further deterioration of his clinical condition. Finally, a repeat biopsy revealed the aspergillus infection. Despite antifungal therapy, the outcome was unfavorable. A high index of suspicion should result in aggressive diagnostic testing and prompt institution of antifungal therapy in patients with primary orbital aspergillosis.
Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA.
Alejandra
A
Decanini-Mancera
Simmons
S
Lessell
Michael S
MS
Lee
Prem S
PS
Subramanian
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D009916:Orbital Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D010400:Penicillin G / Q000627:therapeutic use; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D013588:Syphilis Serodiagnosis; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis; D014794:Visual Fields
D000900:Anti-Bacterial Agents; D010400:Penicillin G; D010401:Penicillin G Benzathine