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Orbital aspergillosis. A fatal masquerader
C M Hutnik1, D A Nicolle, D G Munoz
1Department of Ophthalmology, University of Western Ontario, London, Canada.
Abstract:
Ocular manifestations of aspergillosis are emerging as increasingly more atypical, with a wide spectrum of presentations. The classic teaching is that this fungus presents as an endogenous endophthalmitis in immunocompromised hosts. In most other ocular conditions, the index of suspicion for this infection has typically been low, especially in apparently immunocompetent individuals. However, reports continue to appear that confirm involvement of Aspergillus species in a wide variety of primary ocular and orbital conditions characterized by rapid, uncontrollable progression and, not uncommonly, death. This report highlights a case of autopsy-proven orbital aspergillosis that masqueraded as temporal arteritis in terms of initial clinical presentation and response to standard therapy. Any ocular condition that manifests even subtle atypical features, including temporal arteritis, should be regarded as suspect, and an aggressive approach to secure a biopsy of any involved sites should follow.
Insights
Aspergillosis, a fungal infection, can present atypically in the eye and orbit, even in immunocompetent individuals. Prompt biopsy is crucial for diagnosing aggressive orbital aspergillosis that mimics other conditions like temporal arteritis.
Area of Science:
- Ophthalmology
- Mycology
- Pathology
Background:
- Aspergillosis traditionally presents as endogenous endophthalmitis in immunocompromised patients.
- Ocular aspergillosis diagnosis often has a low index of suspicion, particularly in immunocompetent individuals.
Observation:
- Atypical presentations of ocular and orbital aspergillosis are increasingly reported.
- This case involved orbital aspergillosis mimicking temporal arteritis, showing an unusual clinical presentation.
Findings:
- Autopsy confirmed orbital aspergillosis with a presentation resembling temporal arteritis.
- The condition exhibited rapid, uncontrollable progression, a hallmark of severe Aspergillus involvement.
Implications:
- Ocular conditions with subtle atypical features, including temporal arteritis, warrant high suspicion for fungal infection.
- Aggressive diagnostic approaches, such as biopsy of involved sites, are essential for timely and accurate diagnosis of orbital aspergillosis.