Document Detail


Outcomes of three patients with intracranially invasive sino-orbital aspergillosis.
MedLine Citation:
PMID:  17881994     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Although rare, invasive aspergillosis with intracranial spread usually is fatal and necessitates prompt diagnosis and treatment. We describe the prognoses for survival and vision in 3 consecutive patients with vision-threatening invasive sino-orbital aspergillosis. METHODS: A case series of 3 patients, with review of treatments and outcomes. RESULTS: Three diabetic patients presented with significant eye pain and headache, followed by progressive ophthalmic symptoms including vision loss and limitation of ocular motility. Histologic examination showed numerous hyphae of Aspergillus fumigatus. Following early diagnosis and surgical debridement, 1 patient (case 1) showed vision improvement, from counting fingers to 20/20. The other 2 patients, who were initially treated with corticosteroids after presumptive diagnoses of nonspecific orbital inflammation, showed no recovery of vision from no light perception, and 1 (case 3) died of massive intracranial spread and side effects of antifungal agents caused by delayed diagnosis and long-term use of corticosteroids. CONCLUSIONS: Invasive sino-orbital aspergillosis with intracranial invasion often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. Repeated biopsies often are necessary to rule out fungal sinus infection before considering steroid use, especially in diabetic patients.
Authors:
Jin Sook Yoon; Hyung Kyu Park; Nam Hoon Cho; Sang Yeul Lee
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Ophthalmic plastic and reconstructive surgery     Volume:  23     ISSN:  0740-9303     ISO Abbreviation:  Ophthal Plast Reconstr Surg     Publication Date:    2007 Sep-Oct
Date Detail:
Created Date:  2007-09-20     Completed Date:  2008-01-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8508431     Medline TA:  Ophthal Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  400-6     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology (The Institute of Vision Research), Yonsei University College of Medicine, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Bacterial Agents / therapeutic use
Aspergillosis / drug therapy,  microbiology*,  radiography
Aspergillus fumigatus / isolation & purification
Brain Diseases / drug therapy,  microbiology*,  radiography
Debridement
Eye Infections, Fungal / drug therapy,  microbiology*,  radiography
Fatal Outcome
Female
Humans
Itraconazole / therapeutic use
Magnetic Resonance Imaging
Male
Middle Aged
Orbital Diseases / drug therapy,  microbiology*,  radiography
Paranasal Sinus Diseases / drug therapy,  microbiology*,  radiography
Pyrimidines / therapeutic use
Tomography, X-Ray Computed
Treatment Outcome
Triazoles / therapeutic use
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Pyrimidines; 0/Triazoles; 0/voriconazole; 84625-61-6/Itraconazole

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