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Aspergillosis presenting as an optic neuritis.
Mi Young Choi1, Il Hun Bae, Jong Hoon Lee
1Department of Ophthalmology, College of Medicine, Chungbuk National University & Chungbuk National University Medical Research Institute, Cheongju, Korea.
Korean Journal of Ophthalmology : KJO
|January 28, 2003
Summary
Ocular aspergilloma, a fungal infection, can cause sudden vision loss and eye movement issues. Early diagnosis is challenging, requiring high suspicion and further testing for effective treatment.
Area of Science:
- Ophthalmology
- Mycology
- Neurology
Background:
- A 59-year-old woman presented with sudden right eye vision loss after oral prednisolone treatment for presumed idiopathic optic neuritis.
- Initial brain CT scan revealed no abnormalities, but symptoms progressed, including limited eye movement.
Observation:
- Progressive visual decline and restricted ocular motility in the right eye were noted.
- Magnetic resonance imaging and repeat CT suggested a malignant lesion, later confirmed as Aspergillus fungus colony via histopathology.
Findings:
- Despite surgical intervention and antifungal treatment (intravenous amphotericin B, followed by itraconazole), the patient experienced worsening ptosis, total ophthalmoplegia, and bilateral blindness.
- No visual acuity or extraocular motion recovery was observed during a two-year follow-up.
Implications:
- This case highlights the diagnostic difficulty of ocular aspergilloma presenting with visual loss.
- A high index of suspicion, repeated radiological imaging, and biopsy are crucial for timely diagnosis and management of fungal infections affecting the optic nerve and surrounding structures.