Invasive Fungal Sinusitis Involving the Orbital Apex in a Patient with Chronic Renal Failure

Abstract

An 82-year-old man with chronic renal failure presented with invasive fungal sinusitis involving the right orbital apex. Intravenous liposomal amphotericin B was immediately administered with an intravenous sodium supplement. Subsequently, endoscopic sinus surgery was performed. Aspergillus fumigatus was detected in nasal discharge culture on day 12. Because the patient's renal function had deteriorated by this time, therapy was changed to nasal inhalation of amphotericin B, which was discontinued after 1 month, and oral administration of voriconazole, which was discontinued after 2 months. During 6-month follow-up, the patient did not show recurrence of sinusitis or further decrease in renal function.

Orbital apex syndrome with frontal abscess secondary to sinusitis due to Candida guilliermondii

“…6 Therefore, a substitute of liposomal amphotericin B can be used in this condition. 7 In our case, despite the success in treating the invasive C. guilliermondii infection and preventing a mortal outcome for our patient, the left eye progressed to neovascular glaucoma due to retinal ischemia secondary to the compressive effect of proptosis. Neovascular glaucoma is a devastating secondary glaucoma requiring early diagnosis, followed by immediate and aggressive treatment.…”

Endoscopic Endonasal Optic Nerve Decompression in a Patient With Invasive Fungal Sinusitis Invasion Into the Orbital Apex: Intraoperative Video and Literature Review

“…IFS is a rare but potentially fatal disease that requires prompt diagnosis and treatment. More than 60% of IFS cases involve orbital extension, which is associated with poor visual acuity on the affected side and increased mortality 3,4,10. The rate of recovery of visual acuity can be low even after treatment with antifungal agents and surgery.…”

“…Orbital extension occurs in 60% to 90% of patients with IFS. If IFS invades the orbital apex, the resulting diffuse orbital inflammation can cause visual loss or ophthalmoplegia 3,4. Upon suspicion of IFS invading the orbital apex, treatments such as surgical debridement and administration of antifungal agent should be started immediately.…”

“…If IFS invades the orbital apex, the resulting diffuse orbital inflammation can cause visual loss or ophthalmoplegia. 3,4 Upon suspicion of IFS invading the orbital apex, treatments such as surgical debridement and administration of antifungal agent should be started immediately. However, studies have reported poor outcomes for visual acuity despite such treatment.…”

“…However, studies have reported poor outcomes for visual acuity despite such treatment. [4][5][6] Endoscopic endonasal optic nerve decompression involves removing the wall of the optic canal and decompression of the nerve, and is performed in patients with optic nerve damage caused by sphenoid or posterior ethmoid sinus lesions, maxillofacial trauma, or sellar tumors. 7 Some studies have reported improvement in visual acuity after optic nerve decompression in patients with optic neuritis caused by sinusitis that does not respond to medication and endoscopic sinus surgery.…”