title: Acute chiasmal abscess resulting from perineural extension of invasive sino-orbital aspergillosis in an immunocompetent patient.
abstract: OBJECTIVE
  Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient.
  
  
  METHODS
  A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess.
  
  
  RESULTS
  The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved.
  
  
  CONCLUSIONS
  The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.
authors: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: ileyngo1@health.usf.edu.
authors: Ilya
authors: I
authors: Leyngold
authors: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Alessandro
authors: A
authors: Olivi
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Masaru
authors: M
authors: Ishii
authors: Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Ari
authors: A
authors: Blitz
authors: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Peter
authors: P
authors: Burger
authors: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Prem S
authors: PS
authors: Subramanian
authors: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Gary
authors: G
authors: Gallia
mesh_terms: D000038:Abscess / Q000473:pathology*; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000473:pathology*; D003392:Cranial Sinuses / Q000473:pathology*; D003646:Debridement; D006801:Humans; D007121:Immunocompetence; D007150:Immunohistochemistry; D017964:Itraconazole / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009897:Optic Chiasm / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology; D009916:Orbital Diseases / Q000473:pathology*; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014794:Visual Fields; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D065819:Voriconazole
keywords: Chiasmal abscess; Immunocompetent patients; Invasive sino-orbital aspergillosis; Perineural extension; Vision loss
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