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Published on: March 22, 2012
Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient
Hamad M Alsulaiman1, Sahar M Elkhamary2, Mohammed Alrajeh1
1Oculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Purpose:
Invasive Fungal Sinusitis (IFS) is a potentially life-threatening condition that can progress rapidly to the orbit and the brain, especially if it goes on undetected for a long period. We report a case of a 28-year-old pregnant woman in her second trimester with sino-orbital A spergillosis and subsequent brain involvement who tragically developed deterioration of her neurological status and a spontaneous abortion.
Observations:
The patient presented to the ophthalmology emergency department, King Khaled Eye Specialist Hospital, Riyadh, complaining of left upper eyelid fullness with a palpable eyelid mass and chronic relapsing remitting dull pain for 4 months. Clinical examination was significant for reduced colour vision in the left eye, limited left supraduction, left upper eyelid firm palpable mass, inferior dystopia and proptosis of 4 mm. Magnetic Resonance Imaging (MRI) done without contrast-enhancement due to her pregnancy revealed aggressive infiltrative sinonasal, nasal septum, cribriform plate, orbital, intracranial infiltration with extensive brain edema and midline falcine herniation patterns. Endoscopic endonasal biopsy of the lesions showed septate hyphae branching at acute angles, suggestive of A spergillosis. Her neurological status deteriorated with a spontaneous abortion during admission.
Conclusions And Importance:
This case demonstrates that IFS could present only with proptosis, eyelid fullness, chronic pain without external inflammatory signs and should be considered in such presentation even in immunocompetent patients. Early detection and management are crucial. Whether pregnancy presents a relative immune susceptibility to IFS is an issue that needs further in-depth investigation.
Insights
Invasive fungal sinusitis (IFS) can rapidly spread to the brain and orbit. This case highlights IFS in a pregnant woman presenting with proptosis and eyelid fullness, emphasizing early detection and management.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neurology
Background:
- Invasive Fungal Sinusitis (IFS) is a severe condition with high mortality, often affecting the orbit and brain.
- Early diagnosis is critical, but IFS can present insidiously, especially in specific patient populations.
Observation:
- A pregnant woman in her second trimester presented with chronic eyelid fullness, pain, and reduced vision.
- Imaging revealed extensive sinonasal, orbital, and intracranial involvement with brain edema.
- Biopsy confirmed sino-orbital aspergillosis.
Findings:
- The patient experienced neurological deterioration and a spontaneous abortion during hospitalization.
- Magnetic Resonance Imaging (MRI) without contrast was used due to pregnancy.
- The case underscores IFS presentation with proptosis and eyelid fullness without obvious external inflammation.
Implications:
- IFS should be considered in immunocompetent patients presenting with proptosis and chronic pain.
- Early detection and prompt management are vital for improving outcomes.
- Pregnancy's potential role in immune susceptibility to IFS warrants further investigation.
