title: Orbital apex syndrome caused by invasive aspergillosis.
abstract: A 68-year-old man presented with periorbital pain with progressive decrease in visual acuity of the right eye. The patient began to experience these symptoms 6 months ago, but they had become significantly worse in the last month. On examination, the patient had ptosis, proptosis, and impaired movement of the right eye. His medical history was notable for peripheral T-cell lymphoma. During chemotherapy, he had developed pulmonary aspergillosis, which resolved with antifungal medication. The magnetic resonance imaging scan, which was taken because of orbital symptoms, was suggestive of optic neuritis. For 6 months, his visual symptoms deteriorated and improved with intermittent steroid treatment. However, the patient began to experience worsening pain and visual disturbance for the month leading up to the referral visit and could not recognize light in the involved eye. A repeat magnetic resonance imaging study revealed a diffuse involvement of right orbital apex. Subsequent to this finding, an endoscopic biopsy was performed. The pathologic examination confirmed the diagnosis of invasive aspergillosis. Orbital pain, ptosis, and limitation of eye movements improved with antifungal medication, and the patient was able to recognize hand movements.
authors.affiliation: From the *Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul; and †Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Min Seok
authors.initials: MS
authors.lastname: Rha
authors.forename: Jeong Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Ju Wan
authors.initials: JW
authors.lastname: Kang
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005094:Exophthalmos / Q000209:etiology; D058447:Eye Pain / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D009916:Orbital Diseases / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome; D014786:Vision Disorders / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000935:Antifungal Agents