Acute Chiasmal Abscess Resulting from Perineural Extension of Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

Abstract

OBJECTIVE Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient. CASE DESCRIPTION A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess. RESULTS The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient’s life and vision were preserved. CONCLUSIONS The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.

Visual loss due to paranasal sinus invasive aspergillosis in a diabetic patient

“…Abnormal enhancement of nerve sheath with enhancing soft tissue which infiltrated the optic and facial nerves, respectively, has been well described in the literature. [ 6 7 ] In our case, the patient was not able to wrinkle his forehead and presented with a typical peripheral paralysis of the ipsilateral facial nerve. This was verified by the Neurologist who confirmed the diagnosis and expressed the opinion that the left facial nerve was involved and paralyzed by direct fungal invasion.…”

Successful surgical management of an Escherichia coli epidural–subdural abscess secondary to sino‐rhinotomy

“…infection is an almost universal finding, affecting the nasal turbinates and, less commonly, cribriform plate, orbital, or palatine bones . Extension along the optic nerve in an immunocompetent individuals has been reported, with subsequent chiasmal abscess formation, but no such report exists in the veterinary literature. Additionally, the neural abnormalities detected on imaging by Leyngold et al were not a feature of this case, and the anatomic location of abscessation in our case did not correspond to the origin of the olfactory nerve.…”

Skull base aspergillosis in an immunocompetent elderly man with early response to steroid

“…Intracranial aspergillosis is a rare and often fatal condition, generally affecting immunocompromised patients 1 2. Risk factors for intracranial aspergillosis include allergic rhinosinusitis, nasal polyps and recurrent sinus infections, as well as immunosuppression 2 6 7. The disease can be slowly progressive, and symptoms may persist for months 1.…”

“…The disease can be slowly progressive, and symptoms may persist for months 1. The prognosis is poor, and early diagnosis and aggressive management, with surgical debridement and adjuvant anti-fungal chemotherapy, can help to reduce mortality 1 6 8…”

“…A study of 21 patients with CNS Aspergillus in South India revealed that 76% of patients have intracranial invasion by contiguous spread from paranasal sinuses, with over half the patients presenting with skull base syndromes 8. One Ukrainian case presented with left retro-orbital pain and ipsilateral monocular visual loss, with rapid progression to the contralateral temporal visual field, ptosis and reduced eye movements, secondary to an acute chiasmal abscess caused by Aspergillus fumigatus infection, highlighting invasive sino-orbital aspergillosis in an immunocompetent patient 6. Further case reports have also demonstrated intracranial complications of Aspergillus in immunocompetent patients 2–4 9.…”