Orbital Apex Syndrome in a Patient with Sphenoid Fungal Balls

Cho, Seok Hyun; Jin, Bong Joon; Lee, Yong Seop; Paik, Seung Sam; Ko, Min Jung; Yi, Hyeong-Joong

doi:10.3342/ceo.2009.2.1.52

Cited by 17 publications

(16 citation statements)

References 8 publications

(8 reference statements)

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“…Among the patients with diabetes mellitus, excluding our case, we found only one Science Citation Index case report from 1970 to 2017. [ 11 ] On the basis of Table 1 , there are several similarities between our case and the case reported by Cho et al, [ 11 ] including the age, initial visual acuity, clinical presentation, and image findings. They all had survived after surgical excision and antifungal treatment.…”

Section: Discussionsupporting

confidence: 80%

“…They all had survived after surgical excision and antifungal treatment. The most important difference was final visual acuity, our case having poorer vision than the case reported by Cho et al [ 11 ]…”

Section: Discussioncontrasting

confidence: 61%

“…The clinical characteristics and demographics of these 5 patients and our patient are listed in Table 1 . [ 6 , 11 – 14 ] Of the 6 patients, 4 were immunocompromised and 2 were immunocompetent. The ages of these patients ranged from 43 to 65 years (immunocompromised patients: 52–64 years; immunocompetent patients: 43–65 years).…”

Section: Discussionmentioning

confidence: 99%

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Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

Chang¹,

Chang²,

Chien³

et al. 2018

Medicine

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Rationale:Orbital apex syndrome is a complex clinical disorder featuring a collection of cranial nerve deficits characterized by impairment of the extraocular muscles, the ophthalmic branch of the trigeminal nerve, and even the optic nerve. Sino-orbital aspergillosis is rare but aggressive infection. Surgical resection accompanied by antifungal medication is advised currently.Patient concerns:We report a 61-year-old woman diagnosed as aspergilloma presenting with the characteristic manifestations and imaging features of orbital apex syndrome.Diagnoses:Paranasal sinus tumor was misdiagnosed initially according to magnetic resonance imaging of the orbit. Finally aspergilloma was diagnosed by pathologic report.Interventions:The anti-fungal medication, voriconazole, was administered immediately. Surgical excision was also done due to the poor response to medical treatment.Outcomes:Postoperative follow-up showed no recurrence of aspergillosis but the vision was lost permanently.Lessons:Invasive sino-orbital aspergillosis as an aggressive disease with highly invasive patterns and it may be misdiagnosed as tumors. To achieve better prognosis and survival, clinicians should be aware of this distinct manifestation.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 61%

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Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

Chang¹,

Chang²,

Chien³

et al. 2018

Medicine

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“…Although most of the cases were uncomplicated in this series, SSFB can be associated with orbital ( blindness, reduction of the vision and diplopia) or intracranial (death, meningitis, brain abscess) complications (25,33,35,38,40,41,42) .…”

Section: Microcalcifications 10mentioning

confidence: 68%

Sphenoid sinus fungall ball: a retrospective study over a 10- year period

Eloy¹,

Grenier²,

Pirlet³

et al. 2013

Rhin

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A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease.

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“…Orbital apex or Tolosa-Hunt syndrome is a constellation of cranial neuropathies involving optic, oculomotor, trochlear, abducens, and ophthalmic distribution of trigeminal nerves [3]. It is regarded as a neuro-ophthalmic emergency, therefore requires instant recognition and treatment to avert disastrous consequences.…”

Section: Introductionmentioning

confidence: 99%

An unusual presentation of sphenoid Candida fungal ball: a case report

Tuang

Zahedi

Akashah

et al. 2019

Journal of Surgical Case Reports

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The clinical presentation of a sphenoid fungal ball (FB) is often non-specific and tends to be overlooked, particularly in hosts with an intact immune status. Rarely, potentially life-threatening complications may arise, owning its anatomical characteristics with contiguous structures. Herein, we present an unusual case of sphenoid FB complicated with orbital apex syndrome in an immunocompetent patient. The diagnosis dilemma and subsequent management are further discussed.

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Orbital Apex Syndrome in a Patient with Sphenoid Fungal Balls

Cited by 17 publications

References 8 publications

Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

Sphenoid sinus fungall ball: a retrospective study over a 10- year period

An unusual presentation of sphenoid Candida fungal ball: a case report

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