Blastomyces species and orbital apex syndrome: Unsuspected co-infection

Abstract

species are thermally dimorphic fungi existing as yeast in tissue. We report an initially immunocompetent patient with orbital apex syndrome (OAS) whose presentation suggested giant cell arteritis. Subsequently, metastatic carcinoma was entertained as a cause of OAS until bronchoscopy yielded species. The patient rapidly succumbed with multiorgan failure despite Amphotericin B administration. At post-mortem, co-infection with fungal hyphae in keeping with species was found in cavernous sinus and in infarcted optic nerve. To the best of our knowledge, co-infection with these two organisms in this clinical setting has not been reported.

Orbital apex syndrome due to invasive aspergillosis in an immunocompetent patient

“…OAS due to invasive fungal infection is uncommon and most often caused by Aspergillus or Mucorales spp., particularly in those with immunocompromising conditions or uncontrolled diabetes mellitus. However, cases in immunocompetent individuals have been reported [ 2 , [4] , [5] , [6] , [7] , [8] ]. Urgent treatment with both antimicrobials and surgery is necessary to avoid complications such as complete vision loss and cavernous sinus thrombosis [ 1 ].…”