Invasive Aspergillosis of Right Maxillary Sinus with Orbital Extension in an Immunocompetent Individual

Abstract

Secondary involvement of orbit in aspergillosis following paranasal sinus fungal infection is rare. A case of invasive aspergillosis of right maxillary sinus in a 31-year-old immunocompetent male patient was referred to Ophthalmology OPD with unilateral proptosis. Patient developed proptosis in right eye since six months, which was insidious in onset, progressive, not associated with painful movements. It showed regression since last one month. On examination, best corrected visual acuity was 6/12 in right eye with light projection accurate in all quadrants on presentation, with progressive diminution of vision over 15 days, normal colour vision, pupil was normal in size, reacting to light. Extraocular movements were reduced on lateral side. Left eye examination was within normal limit. Magnetic resonance imaging showed involvement of intra and extraconal compartment upto apex of orbit of right eye, pushing optic nerve medially, with erosion of lamina papyrecea. Intravenous amphotericin B was started and functional endoscopic sinus surgery with maxillary sinus debridement was done. Regular follow-up was kept to prevent the optic nerve involvement.

Keywords

• fungal infection
• neuroaspergillosis
• proptosis