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Abstract
Purpose
To report an immunocompetent patient with more than 1-year survival after treatment with voriconazole, despite invasive paranasal sinus aspergillosis involving the orbital apex.
Case summary:
A 74-year-old woman with only preexisting hypertension visited our clinic complaining of pain and immovable left eye that occurred approximately 4 days prior. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a sphenoid sinusitis with suspicious lesion involving the orbital apex of the left eye. A biopsy by functional endoscopic sphenoid surgery (FESS) was performed through the sphenoid sinus, which enabled us to diagnose aspergillosis. The patient had esotropia, ophthalmoplegia, positive RAPD, and ptosis in the left eye. On follow-up, a new MRI showed acute to subacute stage infarction at the left occipital lobe. After the patient was treated with intravenous voriconazole, ptosis, and ophthalmoplegia improved. At the 13-month follow-up, she was alive with no disease recurrence.
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Figure 1.
At the initial visit, the patient had 30 prism diopters of left esodeviation (E). There was limitation of elevation (A, B, C) and abduction (F) in the left eye.
Figure 3.
Magnetic resonance images (Axial view) showing invasive aspergillosis involving left ethmoid and sphenoid sinuses, left anterior clinoid process, left orbital apex with bony disruption, and lateral and superior wall of the left sphenoid sinus (A). Acute to subacute stage infarction, left occipital lobe (PCA territory) (B).
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