A Case of Invasive Aspergillosis Involing Orbital Apex and Optic Nerve Sheath

Area of Science:

• Ophthalmology
• Neurology
• Mycology

Background:

• Neural spread of fungal infections is uncommon.
• Aspergillosis of the orbital apex and optic nerve sheath is a rare clinical presentation.

Purpose of the Study:

• To report a unique case of primary optic atrophy and orbital aspergillosis.
• To describe the diagnostic and therapeutic approach for fungal infection involving the optic nerve sheath.

Main Methods:

• Case presentation of a 50-year-old diabetic female with unilateral proptosis and optic atrophy.
• Radiological imaging (CT scan) to identify bony erosion.
• Functional endoscopic sinus surgery (FESS) for diagnosis and debulking.
• Microbiological analysis including KOH mount, fungal culture, and histopathology.
• Post-operative antifungal therapy and follow-up.

Main Results:

• Fungal debris identified in the sphenoid sinus, orbital apex, and optic nerve sheath.
• Radiological evidence of bony erosion in the posterior sphenoid sinus wall.
• Histopathological confirmation of Aspergillus fumigatus infection.
• Successful management with FESS and antifungal treatment.

Conclusions:

• Fungal aspergillosis can rarely involve the orbital apex and optic nerve sheath, leading to optic atrophy.
• Early diagnosis through imaging and microbiological studies is crucial.
• Surgical intervention combined with appropriate antifungal therapy is effective in managing this rare condition.