Related Experiment Videos
Aspergillosis related to long-term nasal corticosteroid use
Robert L Bratton1, Paul W Brazis, Walter C Hellinger
1Department of Family Medicine, Mayo Clinic, Jacksonville, Fla 32224, USA.
Abstract:
Aspergillus is a ubiquitous mold that can cause several types of symptomatic infections: allergic aspergillosis, typically in young atopic patients; aspergillomas (often referred to as fungus balls); and invasive aspergillosis, typically seen in debilitated or immunocompromised patients. We describe an 85-year-old woman who was not immunocompromised but had invasive aspergillosis of the paranasal sinus that resulted in unilateral headache and retrobulbar optic neuropathy. After extensive differential diagnostic examination, we concluded that the condition was possibly related to the long-term use of nasal corticosteroids (fluticasone propionate aqueous nasal spray). Surgical removal of solid masses of Aspergillus organisms followed by extended treatment with antifungal agents resulted in a favorable outcome.
Insights
Invasive aspergillosis, a fungal infection, can occur in non-immunocompromised individuals. This case highlights paranasal sinus aspergillosis in an elderly woman, potentially linked to nasal corticosteroid use.
Area of Science:
- Mycology
- Infectious Diseases
- Ophthalmology
Background:
- Aspergillus is a common mold causing various infections like allergic aspergillosis, aspergillomas, and invasive aspergillosis.
- Invasive aspergillosis typically affects immunocompromised or debilitated patients.
Observation:
- A case of invasive aspergillosis in the paranasal sinus of an 85-year-old woman is presented.
- The patient was not immunocompromised but experienced unilateral headache and retrobulbar optic neuropathy.
Findings:
- Extensive diagnostics suggested a possible link between long-term nasal corticosteroid use (fluticasone propionate) and the invasive fungal infection.
- Surgical removal of Aspergillus masses and subsequent antifungal treatment led to a positive outcome.
Implications:
- This case expands the understanding of risk factors for invasive aspergillosis, suggesting nasal corticosteroid use as a potential contributing factor in non-immunocompromised individuals.
- Highlights the importance of considering invasive fungal sinusitis in the differential diagnosis of unilateral headache and optic neuropathy, even in the absence of traditional risk factors.
- Emphasizes the successful management through surgical intervention and antifungal therapy, offering a treatment paradigm for similar complex cases.