Severe bilateral optic neuropathy and meningitis secondary to invasive maxillary sinus aspergillosis Case presentation An 86-year-old man presented with transient amaurosis and headaches. His medical history included uncontrolled diabetes mellitus (elevated hemoglobin A1c: 9.3%). The level of C-reactive protein was moderately elevated (31 mg/L; the erythrocyte sedimentation rate was not assessed), and giant cell arteritis (GCA) complicated by anterior ischemic optic neuropathy was suspected. Several days after the initiation of corticosteroids (0.7 mg/kg/day, administered orally), the patient presented with loss of vision in the left eye and soon developed bilateral blindness with a normal fundus examination. A cerebral computerized tomography (CT) scan showed an Aspergillus-like left maxillary and ethmoidal sinusitis (Figure 1A, B) with invasion to the skull base, including the optic nerve (Figure 1C, D), cavernous sinus, and meninges (Figure 1E, F). The maxillary surgical biopsy tested positive for Aspergillus section Fumigati. Corticosteroids were promptly withdrawn, 5 days after they had first been administered, and replaced with antifungal therapy (initially voriconazole [200 mg, twice
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