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A Murine Model of Ischemic Retinal Injury Induced by Transient Bilateral Common Carotid Artery Occlusion
Published on: November 12, 2020
Central retinal artery occlusion as a rare complication of trichoderma-associated acute invasive fungal sinusitis
Li Farong1, Li Xiaodong2, Qin Xuewei3
1Department of Ophthalmology, The First People's Hospital of Changde City, Changde, Hunan Province, P.R. China.
Background:
Acute invasive fungal sinusitis (AIFRS) is a life-threatening infection characterized by fungal hyphen invading the nasal mucosal, blood vessels, and nerves, leading to tissue necrosis. It often complicates intracranial infection with a high mortality rate. Ocular manifestations can indicate intracranial or systemic infection. This article reports a rare case of AIFRS complicated by central retinal artery occlusion (CRAO) caused by Trichoderma infection to provide a reference for early diagnosis and treatment.
Case Presentation:
A 45-year-old male with undiagnosed diabetes presented with left facial numbness, periodontal pain, and progressive vision loss. Initial misdiagnosis of the patient as having facial neuritis delayed anti-fungal therapy. Despite intensive care unit (ICU) admission and surgical debridement, the patient succumbed to sepsis and intracranial infection. Ophthalmic imaging confirmed CRAO, with fundus fluorescein angiography (FFA) revealing arterial occlusion.
Conclusions:
This case underscores the need for early recognition of AIFRS in high-risk patients and systematic ophthalmic evaluation in cases of rapid vision loss. Multidisciplinary collaboration and cautious use of corticosteroids are critical. International guidelines recommend prompt anti-fungal therapy, but thrombolysis for CRAO remains controversial in systemic fungal infections.
Insights
Acute invasive fungal sinusitis (AIFRS) can lead to vision loss from central retinal artery occlusion (CRAO). Early diagnosis and prompt antifungal treatment are crucial for high-risk patients to prevent severe complications.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Mycology
Background:
- Acute invasive fungal sinusitis (AIFRS) is a severe infection with high mortality, often involving the sinuses and potentially spreading to the brain.
- Ocular complications can signal widespread infection, necessitating thorough ophthalmic examination.
Purpose of the Study:
- To report a rare case of AIFRS caused by Trichoderma infection.
- To highlight the association between AIFRS and central retinal artery occlusion (CRAO).
- To emphasize the importance of early diagnosis and treatment for AIFRS with ocular manifestations.
Main Methods:
- A case study of a 45-year-old male with diabetes presenting with facial numbness and vision loss.
- Delayed diagnosis and treatment due to initial misdiagnosis.
- Ophthalmic imaging, including fundus fluorescein angiography (FFA), confirmed CRAO.
Main Results:
- The patient developed AIFRS complicated by CRAO.
- Despite ICU care and surgical intervention, the patient died from sepsis and intracranial infection.
- FFA confirmed arterial occlusion as the cause of vision loss.
Conclusions:
- Early recognition of AIFRS in high-risk individuals is vital.
- Systematic ophthalmic evaluation is essential for patients with rapid vision loss.
- Multidisciplinary collaboration and judicious corticosteroid use are critical; thrombolysis for CRAO in fungal infections remains debated.
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