Journal Article

Orbital aspergillosis in immunocompetent patients

Ali, Mohammad Javed, Vemuganti, Geeta K, Nalamada, Suma, Honavar, Santosh G, Mody, Kruti H, Naik, Milind N

2014

Overview

Purpose To describe clinical, ultrasonographic, radiological and histopathological features of orbital aspergillosis in immunocompetent patients. Methods Medical records of immunocompetant individuals with orbital aspergillosis between November 1995 and November 2010 were reviewed. Results Thirty-five cases (27 males, 8 females) were reviewed. Mean age at presentation was 37.63 (8–73) years and mean duration of symptoms was 12.03 (0.5–84) months. Proptosis (22.63%) and mass lesion (13.37%) were the commonest presenting complaints. Presenting visual acuity was better than 6/9 in 21 (60%) and no perception of light in 3 (8%). Ocular motility restriction was noted in 25 (71%). The commonest clinical differential diagnosis was non-specific orbital inflammatory disease (NSOID) (10.29%) followed by malignancy (7.20%). CT showed infiltrative lesions with bone destruction in 22 (63%), contiguous paranasal sinus involvement in 22 (63%) and intracranial extension in 10 (29%). Diagnosis was by histopathology and microbiological evaluation. Fungal cultures revealed Aspergillus flavus in 30 (86%) and Aspergillus fumigatus in 5 (14%). Treatment included conservative medical management in 18 (51%) and surgical debulking in 17 (49%). Average follow-up was 37.6 (3–183) months, and patient survival was 33/35 (94%). Conclusions Though orbital aspergillosis is commonly seen in immunocompromised patients, it should be suspected in young immunocompetent individuals presenting with proptosis of insidious onset and infiltrating lesions involving the paranasal sinuses. Definitive diagnosis is achieved by histopathological and microbiological evaluation. Systemic steroids should be avoided prior to definitive diagnosis. Prolonged systemic antifungal therapy with an option of additional debulking of lesions provides good disease control with improved survival.

• Publisher: BMJ Publishing Group LTD
• Subject: Adolescent / Adult / Aged / Antifungal Agents - therapeutic use / Aspergillosis - diagnosis / Aspergillosis - microbiology / Aspergillosis - therapy / Aspergillus flavus / Aspergillus flavus - isolation & purification / Aspergillus fumigatus / Aspergillus fumigatus - isolation & purification / Biopsy / Child / Combined Modality Therapy / Diagnosis, Differential / Disease / Eye Infections, Fungal - diagnosis / Eye Infections, Fungal - microbiology / Eye Infections, Fungal - therapy / Female / Humans / Immunocompetence / Male / Middle Aged / Mortality / Motility / Ocular Motility Disorders - diagnosis / Ocular Motility Disorders - microbiology / Ocular Motility Disorders - therapy / Ophthalmologic Surgical Procedures / Orbital Diseases - diagnosis / Orbital Diseases - microbiology / Orbital Diseases - therapy / Retrospective Studies / Sinuses / Tomography, X-Ray Computed / Vision Disorders - diagnosis / Vision Disorders - microbiology / Vision Disorders - therapy / Visual Acuity - physiology / Young Adult