Breaking the Mold of Orbital Cellulitis

Surgical neurology, 2008

Background: Aspergillosis of the paranasal sinuses is infrequent and usually involves the species Aspergillus fumigatus and A. flavus. The maxillary sinus is the most common sinus to be affected. Invasive cranio-orbital aspergillosis originating in the sphenoid sinus is rare and mostly occurs in immunocompromised patients with poor outcomes. We present a case of invasive A. terreus sphenoidal sinusitis with intraorbital and intracranial extension in an immunocompetent patient. Case Description: This 62-year-old man presented with a 2-month history of left retroorbital pain followed by rapid decreasing vision and 2 episodes of epistaxis. Ophthalmologic examination revealed no light perception left. Computed tomographic scan and MR images demonstrated an enhanced sphenoid lesion within the left sphenoid sinus with bone destruction and intraorbital and cavernous sinus extensions. A malignant tumor was suspected. The patient underwent a transphenoidal biopsy of the sphenoid mass. Histologic analysis revealed numerous Aspergillus hyphea, and the species A. terreus was isolated from fungal cultures of specimens. No systemic fungal infection was found, and the patient had no evidence of immunosuppression. After 3 months' administration of oral voriconazole, the patient became well, and the orbitocranial mass regressed in size. It was stabilized on the ninth postoperative month. Conclusion: A. terreus sinusitis with orbitocranial extension had never been reported in the literature. Even in an immunocompetent host, ISOA is difficult to eradicate using surgical debridement combined with optimal antifungal agents because of the intracranial extension and the relative resistance of conventional antifungal therapy. Early diagnosis is important to prevent an unfavorable outcome of this emergent infection.

Mycoses, 2015

Severely immunocompromised patients such as those with haematological malignancies and haematopoietic stem cell transplant recipients are at an increased risk of acquiring invasive mould infections. Fusarium, a ubiquitous fungus, can cause potentially fatal infections in such hosts. It usually manifests as skin lesions, fevers and sino-pulmonary infections. Brain abscesses have been reported, but are relatively uncommon. We report a case of a 50-year-old patient with acute lymphocytic leukaemia and failed autologous peripheral stem cell transplant that presented with new onset seizures and was found to have Fusarium solani brain abscess. Nasal route was the presumed mode of entry of the fungus into the cerebrum. Treatment comprised surgical excision of the lesion, and antimycotic therapy with liposomal amphotericin B and voriconazole. Despite aggressive therapy, patient succumbed to the disease. We have provided an overview of infections secondary to Fusarium, along with a review of...

2018

Orbital cellulites is an uncommon infectious process in which patient may present with pain, reduced visual acuity, compromised ocular motility and significant proptosis. [1][3] In the modern era of relatively early access to the health care facilities, complete loss of vi‐ sion from orbital cellulitis is rare. In the vast majority of cases, a history of upper respirato‐ ry tract infection prior to the onset is very common especially in children. [4], [5] Chandler et al, [6] for simplicity has classified the disease into 5 categories and emphasized the pos‐ sibility of fatal outcome due to the extension of the abscess to cavernous sinus in the form of thrombosis and intracranial spread. In addition to the loss of vision, orbital cellulitis can be associated with a number of other serious complications that may include intracranial complications in the form of cavernous sinus thrombosis, meningitis, frontal abscess and even death. Historically, since the wide spread use of effective ...

Ophthalmology Journal

BaCkground: Orbital cellulitis is an infectious involvement of the tissues posterior to the orbital septum causing severe local and general complications. Material and Methods: The aim of our work was to study the clinical, paraclinical and therapeutic characteristics of orbital cellulitis through a retrospective study of 89 cases collected between 2015 and 2019. The diagnosis of orbital cellulitis was based on clinical and imaging elements. results: The average age was 17.5 years. Exophthalmos was noted in 33% of cases, ophthalmoplegia in 18% of cases, diplopia in 4.5% of cases and ocular hypertonia in 11% of cases. Orbital CT scan allowed the diagnosis of subperiosteal abscess in 20% of cases and orbital abscess in 10% of cases. Sinusitis was the main infectious origin in children, while dacryocystitis predominated in adults. All patients received parenteral antibiotherapy combined with corticotherapy after 48 hours. Complications occurred in 10 cases, dominated by exposure keratitis, panophthalmitis and optic atrophy with permanent blindness. ConClusions: We emphasize the importance of rapid diagnosis and urgent treatment of orbital cellulitis.

Common Eye Infections, 2013

Acta Ophthalmologica Scandinavica, 2004

To describe a case of corneal abscess caused by Fusarium solani that did not respond to common antifungal agents. Method: Case report. Results: Twenty days after accidental contact with vegetation, a 56-year-old man presented with a corneal abscess. Corneal ulceration developed and a perforating keratoplasty was performed. After a microbiological examination, the diagnosis of F. solani infection was made. Systemic and topical amphotericin B and fluconazole were prescribed, with no results. A new abscess formed on the transplanted graft and a wound leak developed. We administered topical and systemic voriconazole. No side-effects were observed. The choroidal detachment and the surgical transplant recovered completely in 20 days. A vascular leukoma developed at the site of the transplanted corneal abscess. Conclusion: From a functional point of view, another corneal transplant will be necessary. Voriconazole was effective in treating a severe keratomycosis caused by F. solani that was resistant to other topical and systemic antifungal agents.

Ophthalmic Plastic & Reconstructive Surgery, 2009

Purpose: To report a series of 7 cases of orbital abscess with unusual features that may mimic other cystic orbital lesions. Methods: Retrospective study of all cases of orbital cellulitis/abscess treated at our center, over 1 year, highlighting cases with unusual features. Results: Thirty-one cases were studied, where orbital cellulitis/abscess was the final diagnosis. Of these, 7 patients did not have typical signs and/or symptoms of local infection. At presentation, there was no associated predisposing risk factor, indicating the source of infection. The duration of symptoms, among these 7 patients, ranged from 3 weeks to 6 months. The initial diagnosis was myocysticercosis in 3 cases, orbital dermoid in 1 case, lymphangioma in 1 case, pseudotumor in 1 case, and schwannoma in 1 case. Conclusions: Unusual presentations of orbital abscess can mimic other conditions of the orbit. Orbital abscess should be considered in the differential diagnosis if a cystic lesion has not responded or partly responded to systemic antibiotics and there are associated signs or symptoms of intermittent or constant low-grade inflammation, even in the absence of predisposing risk factors.

Medical Mycology, 2002

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2000

Twenty patients with orbital cellulitis were treated over a seven-year period. All patients had a CT scan for localization and categorization of the disease. Fourteen of sixteen patients with post-septal involvement underwent surgical drainage and orbital exploration via an external ethmoidectomy approach. Two of these fourteen patients also had an optic nerve decompression. Clinical signs were found to be accurate in differentiating pre-septal from post-septal cellulitis tut were inadequate for further categorization of the type of post-septal cellulitis. All ten patients with pre-septal cellulitis or a post-septal subperiosteal abscess recovered with preservation of vision. Mild to moderate degrees of visual loss could be reversed with emergent surgical treatment even after 10 days from the onset of visual loss. Post-septal intraperiosteal orbital cellulitis and orbital abscess however resulted in significant permanent visual disability in eight of ten cases.

The Southeast Asian journal of tropical medicine and public health, 2012

Fungal endophthalmitis is a destructive intraocular infection resulting in poor visual prognosis. Endophthalmitis due to Fusarium spp has the worst visual prognosis. We report a case of a 58-year-old female patient who underwent cataract extraction and intraocular lens implantation in the right eye and presented two months after the surgery with fungal endophthalmitis. The aqueous humor culture grew Fusarium dimerum. The patient was treated with intravitreal and oral voriconazole and topical prednisolone. The patient experienced one episode of recurrence following by remarkable improvement. To our knowledge, this is the first reported case of Fusarium dimerum endophthalmitis.

Otolaryngology-Head and Neck Surgery, 1998

Aspergillus fumigatus is the most common fungal pathogen of the paranasal sinuses. Its clinical significance ranges from noninvasive colonization to fulminant invasion of the sinuses and surrounding structures. Immunocompromised individuals are at highest risk for invasive infection. While the maxillary sinus is most commonly affected, isolated sphenoid sinusitis is infrequent. 1 Complications of sphenoid involvement result from extension into contiguous structures such as the orbit, cavernous sinus, or brain. Prompt diagnosis and treatment are paramount to reducing morbidity and mortality. Superior orbital fissure syndrome includes ophthalmoplegia, ptosis, forehead hypesthesia, and retro-orbital pain. Any process that invades the superior orbital fissure may lead to this constellation of findings. We report a case of indolent Aspergillus sphenoid sinusitis presenting as a superior orbital fissure syndrome over a 6-week period. The unusual clinical and radiologic features of this report that led to a delay in diagnosis and treatment are detailed.

Current Eye Research, 2009

Journal of Ophthalmic and Vision Research, 2018

Infections of the orbit and periorbita are relatively frequent, and can cause significant local and systemic morbidity. Loss of vision occurs in more than 10% of patients, and systemic sequelae can include meningitis, intracranial abscess, and death. Numerous organisms infect the orbit, but the most common are bacteria. There are many methods through which orbital infections occur, with infection from the neighboring ethmoid sinuses the most likely cause for all age groups. Prompt management is essential in suspected orbital cellulitis, and involves urgent intravenous antibiotics, rehydration, and treatment of any co-existent underlying systemic disease, e.g., diabetes, renal failure. This review summarizes the common infectious processes of the orbit in both pediatric and adult groups. We review pathophysiology, symptoms, signs, and treatment for infectious orbital processes.

Ophthalmic Plastic and Reconstructive Surgery, 2001

2021

Candida guilliermondii is an opportunistic pathogen that rarely causes invasive candidiasis even in immunocompromised humans. We report a case presentation of invasive C. guilliermondii rhinosinusitis causing an orbital and intracranial extension (frontal lobe abscess). An aggressive multidisciplinary team management is a key approach in invasive fungal sinusitis and avoided mortality in this case. When orbital apex syndrome secondary to sinusitis is encountered in an immunocompromised patient, the treating physician should consider fungal infection as a causative agent.