Acute chiasmal abscess resulting from perineural extension of invasive sino-orbital aspergillosis in an immunocompetent patient.

Abstract

OBJECTIVE:

Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient.

CASE DESCRIPTION:

A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess.

RESULTS:

The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved.

CONCLUSIONS:

The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.

• Authors: Ilya Leyngold, Alessandro Olivi, Masaru Ishii, Ari Blitz, Peter Burger, Prem S Subramanian, Gary Gallia
• Journal: World neurosurgery (World Neurosurg) Vol. 81 Issue 1 Pg. 203.e1-6 (Jan 2014) ISSN: 1878-8769 [Electronic] United States
• PMID: 23973515 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Itraconazole
• Voriconazole

Topics

• Abscess (pathology)
• Antifungal Agents (therapeutic use)
• Aspergillosis (complications, pathology)
• Cranial Sinuses (pathology)
• Debridement
• Humans
• Immunocompetence
• Immunohistochemistry
• Itraconazole (therapeutic use)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuroimaging
• Optic Chiasm (pathology)
• Optic Nerve (pathology)
• Orbital Diseases (pathology)
• Pyrimidines (therapeutic use)
• Triazoles (therapeutic use)
• Visual Fields
• Voriconazole