title: Orbital Apex Syndrome Caused by Invasive Aspergillosis as an Adverse Effect of Systemic Chemotherapy for Metastatic Colorectal Cancer: a Case Report.
abstract: Continuous therapy with cytotoxic drugs suppresses humoral immune function and may result in local infection. We present a case of orbital apex syndrome caused by Aspergillus infection during chemotherapy for metastatic colorectal cancer. A 74-year-old man with colorectal liver metastases under long-term continuous systemic chemotherapy presented with painful, progressive orbital apex syndrome. Magnetic resonance imaging disclosed a small enhancing lesion around the right ethmoid sinus. We initially diagnosed colorectal cancer metastasis and he underwent biopsy via the endoscopic endonasal transethmoid approach. However, pathological examination of the cultured specimen revealed Aspergillus fumigatus. The patient was treated with voriconazole and the orbital apex syndrome resolved after 1 month. Orbital aspergillosis is a life-threatening disease and should be listed as a differential diagnosis of uncommon local infections during continuous chemotherapy.
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Yuji
authors: Y
authors: Miyamoto
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Yasuo
authors: Y
authors: Sakamoto
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Mayuko
authors: M
authors: Ohuchi
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Ryuma
authors: R
authors: Tokunaga
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Hironobu
authors: H
authors: Shigaki
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Junji
authors: J
authors: Kurashige
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Masaaki
authors: M
authors: Iwatsuki
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Yoshifumi
authors: Y
authors: Baba
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Naoya
authors: N
authors: Yoshida
authors: Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Watanabe
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan hdobaba@kumamoto-u.ac.jp.
authors: Hideo
authors: H
authors: Baba
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001228:Aspergillosis / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity*; D001706:Biopsy; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D058447:Eye Pain / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D009894:Opportunistic Infections / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: Orbital apex syndrome; aspergillosis; metastatic colorectal cancer; systemic chemotherapy