Abstract
Invasive aspergillosis is a rare disease and is often misdiagnosed. The clinical course is quite aggressive and it is a potentially fatal disease. We report a case of invasive aspergillosis involving the dura mater and optic nerves which was successfully treated with voriconazole, even though the patient had residual monocular blindness. An 86-year-old Japanese man complained of developing loss of vision in his left eye while taking oral fluconazole prescribed by an otolaryngologist for mycosis of the left maxillary sinus. He was referred to our hospital. At the first visit, he already had no light perception in the left eye, with decreased ocular motility in all directions and orbital apex syndrome. His corrected distance visual acuity (CDVA) in the right eye was 20/25 with enlargement of Mariotte’s blind spot. Magnetic resonance imaging revealed inflammation around both optic nerves that also involved the dura mater. His antifungal therapy was changed to intravenous voriconazole. Although his right CDVA temporarily declined to 20/50, it improved to 20/16 by 10 months after the initiation of treatment. Maxillary sinus biopsy detected Aspergillus. Invasive aspergillosis progresses rapidly and aggressively. The present case highlights the importance of early diagnosis and selection of an appropriate antifungal agent.
References
Levin LA, Avery R, Shore JW, Woog JJ, Baker AS (1996) The spectrum of orbital aspergillosis: a clinicopathological review. Surv Ophthalmol 41:142–154
De Shazo RD, Chapin K, Swain RE (1997) Fungal sinusitis. N Engl J Med 337:254–259
Sivak-Callocott JA, Livesley N, Nugent RA, Rasmussen SL, Saeed P, Rootman J (2004) Localised invasive sino-orbital aspergillosis: characteristic features. Br J Ophthalmol 88:681–687
Pushker N, Meel R, Kashyap S, Bajaj MS, Sen S (2011) Invasive aspergillosis of orbit in immunocompetent patients: treatment and outcome. Ophthalmology 118:1886–1891
DelGaudio JM, Swain RE Jr, Kingdom TT, Muller S, Hudgins PA (2003) Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 129:236–240
Obayashi T, Yoshida M, Mori T et al (1995) Plasma (1 → 3)-β-d-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 345:17–20
Nakanishi W, Fujishiro Y, Nishimura S, Fukaya T (2009) Clinical significance of (1 → 3)-β-d-glucan in a patients with invasive sino-orbital aspergillosis. Auris Nasus Larynx 36:224–227
Dhiwakar M, Thakar A, Bahadur S (2003) Invasive sino-orbital aspergillosis: surgical decisions and dilemmas. J Laryngol Otol 117:280–285
Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, van Burik JA, Wingard JR, Patterson TF (2008) Treatment of aspergillosis: clinical practice guidelines of the Infectious Disease Society of America. Clin Infect Dis 46:327–360
Gilbert DN, Moellering RC Jr, Eliopoulos GM, Chambers HF, Saag MS (2012) At a glance summary of suggested antifungal drugs against treatable pathogenic fungi. In: Gilbert DN, Moellering RC Jr, Eliopoulos GM, Chambers HF, Saag MS (eds) Sanford guide to antimicrobial therapy 2012. Antimicrobial therapy, 42nd edn. Sperryville, Sperryville, p 125
Acknowledgments
We wish to thank Kazuki Sato (board certified pharmacist in infection control at Saiseikai Kurihashi Hospital) for advice about antifungal agents.
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None of the authors have a conflict of interest to disclosure.
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Arakawa, H., Suto, C., Notani, H. et al. Selection of the antifungal agent decides prognosis of invasive aspergillosis: case report of a successful outcome with voriconazole. Int Ophthalmol 34, 85–89 (2014). https://doi.org/10.1007/s10792-013-9730-x
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DOI: https://doi.org/10.1007/s10792-013-9730-x