A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis

Sung Il Kim; Hee Young Choi; Ji Woong Lee

doi:10.3341/jkos.2014.55.1.149

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Kim, Choi, and Lee: A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis

Original Article

J Korean Ophthalmol Soc 2014;55(1):149-154.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.1.149

A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis

Sung Il Kim, MD, Hee Young Choi, MD, PhD, Ji Woong Lee, MD

Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Ji Woong Lee, MD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea, Tel: 82-51-240-7326, Fax: 82-51-242-7341, E-mail: glaucoma@pusan.ac.kr

Received 18 January 201323 April 2013 Accepted 20 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of orbital aspergillosis with third nerve palsy.

Case summary

A 75-year-old male presented with abrupt onset of visual impairment, extraocular movement limitation, and ptosis. The patient previously experienced rhinolalia and headache and was diagnosed with sinusitis 2 months prior, and was treated with oral antibiotics for 1 week. Orbital magnetic resonance imaging revealed a mass with bone erosion including the nasal cavity, ethmoid bone, and left orbit suggestive of fugal sinusitis. Aspergillus was detected histopathologi-cally in the mass which was removed by endoscopic surgery. Amphotericin B was administered intravenously for 7 days along with voriconazole. There was no recurrence during the follow-up period. Extraocular movement limitations and ptosis were recovered postoperatively.

Conclusions

The present study results indicate that visual impairment and third nerve palsy can develop in a patient with orbital aspergillosis.

Keywords: Orbital aspergillosis, Third nerve palsy

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Figure 1.

Photograph at presentation shows ptosis of the left eye.

Figure 2.

Nine cardinal gaze photograph shows limitation of adduction, elevation, and depression of the left eye.

Figure 3.

Fundus photo at presentation shows both pale optic disc and increased cup-disc ratio.

Figure 4.

Brain magnetic resonance imaging at initial visit. (A) Coronal T1-weighted image shows marked heteroge-neous enhancement of the left extracornal region (arrow) and mucosal thickening with enhancement in the right para-nasal sinus and destruction of maxillary bone structures (arrowhead). (B) Axial T2-weighted image shows hyper-intense mass-like lesion of the pterygopalatine fossa, vidian canal, and cavernous sinus (arrowhead).

Figure 5.

Brain magnetic resonance imaging with angiography at initial visit. Image shows focal severe stenosis on C3 segment of the left internal carotid artery by mass effects (arrow).

Figure 6.

Histopathologic examination revealed septated fun-gal hyphae consistent with Aspergillosis fumigatus (H&E stain ×200).

Figure 7.

Postoperative computed tomography. (A) Coronal view without enhancement scan demonstrates no extraconal mass compressing the orbit (arrow). (B) Axial view without enhancement scan demonstrates decrease in the extent of en-hancing soft tissue density in the left orbit, pterygopalatine fossa, vidian canal, and cavernous sinus (arrowhead).

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