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Retrobulbar optic neuropathy associated with sphenoid sinus mucormycosis
Tatsuhiko Sano1,2, Zen Kobayashi1, Ken Takaoka1,2
1Department of Neurology JA Toride Medical Center Toride Ibaraki Japan.
Neurology and Clinical Neuroscience
|October 19, 2018
Summary
Invasive fungal sinusitis (IFS) can mimic other conditions. This case highlights that IFS may present as isolated optic neuropathy, not just orbital apex syndrome.
Area of Science:
- Ophthalmology
- Otorhinolaryngology
- Infectious Diseases
Background:
- Invasive fungal sinusitis (IFS) typically spreads to the orbital apex.
- This often results in orbital apex syndrome (OAS), affecting multiple cranial nerves.
- However, atypical presentations can occur.
Purpose of the Study:
- To report a rare case of sphenoid sinus mucormycosis presenting as isolated retrobulbar optic neuropathy.
- To emphasize the importance of considering IFS in the differential diagnosis of optic nerve dysfunction.
Main Methods:
- Case report of a 94-year-old female with acute unilateral blindness.
- Diagnostic imaging (Head MRI) to identify sphenoid sinus mass contiguous with the optic nerve.
- Endoscopic sinus surgery for diagnosis and debulking, followed by antifungal treatment.
Main Results:
- Histopathological diagnosis confirmed mucormycosis.
- The patient presented with isolated retrobulbar optic neuropathy.
- Successful treatment with liposomal amphotericin B led to mass reduction and no recurrence over 1 year.
Conclusions:
- Invasive fungal sinusitis can present atypically as isolated retrobulbar optic neuropathy.
- Clinicians should maintain a high index of suspicion for IFS in patients with unexplained optic nerve deficits.
- Prompt diagnosis and treatment are crucial for favorable outcomes.
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