Severe bilateral optic neuropathy and meningitis secondary to invasive maxillary sinus aspergillosis

Abstract

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 Corticosteroids were promptly withdrawn, 5 days after they had first been administered, and replaced with antifungal therapy (initially voriconazole [200 mg, twice

Challenging Diagnosis of Invasive Sinus Aspergillosis Mimicking Gradenigo’s Syndrome in an Elderly Patient with T-Cell Lymphoma

“…Invasive paranasal sinus aspergillosis is a rare fatal condition mostly observed in immunocompromised patients. Moreover, the early diagnosis of this entity is a challenge due to the heterogeneity of the clinical manifestations [ 6 ]. To the best of our knowledge, this is the first published case of an elderly patient with T-cell lymphoma complicated by invasive sinus aspergillosis mimicking GS.…”

“…5 Amphotericin-B dose was increased to 5 mg/kg IV. 6 Treatment was associated with Acyclovir at a dose of 500 mg administered every 8 h orally. 7 Neurological physical examination suggested palsy of the sixth and seventh cranial nerves (CN), along with numbness in the distribution of the fifth CN (V1).…”

“…5 Amphotericin-B dose was increased to 5 mg/kg IV. 6 Treatment was associated with Acyclovir at a dose of 500 mg administered every 8 h orally. 7 The following day, the patient developed fever and neutropenia, so a treatment with a liposomal formulation of amphotericin-B administered at a dose of 3 mg/kg IV along with high doses of IV acyclovir was started.…”

“…Treatment was initiated with liposomal preparation of amphotericin-B at a dose of 3 mg/kg administered IV 5. Amphotericin-B dose was increased to 5 mg/kg IV 6. Treatment was associated with Acyclovir at a dose of 500 mg administered every 8 h orally 7.…”