Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient
Purpose: Invasive Fungal Sinusitis (IFS) is a potentially life-threatening condition that can progress rapidly to the orbit and the brain, especially if it goes on undetected for a long period. We report a case of a 28-year-old pregnant woman in her second trimester with sino-orbital Aspergillosis a...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S245199362100219X |
| _version_ | 1818574792828125184 |
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| author | Hamad M. Alsulaiman Sahar M. Elkhamary Mohammed Alrajeh Osama Al-Alsheikh Huda Al-Ghadeer |
| author_facet | Hamad M. Alsulaiman Sahar M. Elkhamary Mohammed Alrajeh Osama Al-Alsheikh Huda Al-Ghadeer |
| author_sort | Hamad M. Alsulaiman |
| collection | DOAJ |
| description | Purpose: Invasive Fungal Sinusitis (IFS) is a potentially life-threatening condition that can progress rapidly to the orbit and the brain, especially if it goes on undetected for a long period. We report a case of a 28-year-old pregnant woman in her second trimester with sino-orbital Aspergillosis and subsequent brain involvement who tragically developed deterioration of her neurological status and a spontaneous abortion. Observations: The patient presented to the ophthalmology emergency department, King Khaled Eye Specialist Hospital, Riyadh, complaining of left upper eyelid fullness with a palpable eyelid mass and chronic relapsing remitting dull pain for 4 months. Clinical examination was significant for reduced colour vision in the left eye, limited left supraduction, left upper eyelid firm palpable mass, inferior dystopia and proptosis of 4 mm. Magnetic Resonance Imaging (MRI) done without contrast-enhancement due to her pregnancy revealed aggressive infiltrative sinonasal, nasal septum, cribriform plate, orbital, intracranial infiltration with extensive brain edema and midline falcine herniation patterns. Endoscopic endonasal biopsy of the lesions showed septate hyphae branching at acute angles, suggestive of Aspergillosis. Her neurological status deteriorated with a spontaneous abortion during admission. Conclusions and Importance: This case demonstrates that IFS could present only with proptosis, eyelid fullness, chronic pain without external inflammatory signs and should be considered in such presentation even in immunocompetent patients. Early detection and management are crucial. Whether pregnancy presents a relative immune susceptibility to IFS is an issue that needs further in-depth investigation. |
| first_indexed | 2024-12-15T00:30:49Z |
| format | Article |
| id | doaj.art-c69a1c063d414871a207ab4808564b24 |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-15T00:30:49Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-c69a1c063d414871a207ab4808564b242022-12-21T22:42:01ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362021-12-0124101210Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patientHamad M. Alsulaiman0Sahar M. Elkhamary1Mohammed Alrajeh2Osama Al-Alsheikh3Huda Al-Ghadeer4Oculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi ArabiaDepartment of Radiology, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaOculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi ArabiaOculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi ArabiaEmergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Corresponding author. Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, 11462, Riyadh, Saudi Arabia.Purpose: Invasive Fungal Sinusitis (IFS) is a potentially life-threatening condition that can progress rapidly to the orbit and the brain, especially if it goes on undetected for a long period. We report a case of a 28-year-old pregnant woman in her second trimester with sino-orbital Aspergillosis and subsequent brain involvement who tragically developed deterioration of her neurological status and a spontaneous abortion. Observations: The patient presented to the ophthalmology emergency department, King Khaled Eye Specialist Hospital, Riyadh, complaining of left upper eyelid fullness with a palpable eyelid mass and chronic relapsing remitting dull pain for 4 months. Clinical examination was significant for reduced colour vision in the left eye, limited left supraduction, left upper eyelid firm palpable mass, inferior dystopia and proptosis of 4 mm. Magnetic Resonance Imaging (MRI) done without contrast-enhancement due to her pregnancy revealed aggressive infiltrative sinonasal, nasal septum, cribriform plate, orbital, intracranial infiltration with extensive brain edema and midline falcine herniation patterns. Endoscopic endonasal biopsy of the lesions showed septate hyphae branching at acute angles, suggestive of Aspergillosis. Her neurological status deteriorated with a spontaneous abortion during admission. Conclusions and Importance: This case demonstrates that IFS could present only with proptosis, eyelid fullness, chronic pain without external inflammatory signs and should be considered in such presentation even in immunocompetent patients. Early detection and management are crucial. Whether pregnancy presents a relative immune susceptibility to IFS is an issue that needs further in-depth investigation.http://www.sciencedirect.com/science/article/pii/S245199362100219XOrbitAspergillosisPregnancyImmunocompetentInvasive fungal sinusitis |
| spellingShingle | Hamad M. Alsulaiman Sahar M. Elkhamary Mohammed Alrajeh Osama Al-Alsheikh Huda Al-Ghadeer Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient American Journal of Ophthalmology Case Reports Orbit Aspergillosis Pregnancy Immunocompetent Invasive fungal sinusitis |
| title | Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient |
| title_full | Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient |
| title_fullStr | Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient |
| title_full_unstemmed | Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient |
| title_short | Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient |
| title_sort | invasive sino orbital aspergillosis with brain invasion in an immunocompetent pregnant patient |
| topic | Orbit Aspergillosis Pregnancy Immunocompetent Invasive fungal sinusitis |
| url | http://www.sciencedirect.com/science/article/pii/S245199362100219X |
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