A case of noninvasive sinus aspergillosis showing orbital apex syndrome

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  • Tanaka Akihiro
    Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Yoshida Tomokatsu
    Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Isayama Reina
    Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Fujiwara Yasuhiro
    Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Kasai Takashi
    Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Nakagawa Masanori
    Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine

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Other Title
  • 眼窩先端症候群を呈した非浸潤型副鼻腔アスペルギルス感染症の１例
  • ガンカ センタン ショウコウグン オ テイシタ ヒシンジュンガタ フクビコウ アスペルギルス カンセンショウ ノ 1レイ

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Description

A 78-year-old man was admitted to our hospital with headache, nasal pain, left-sided ptosis, loss of visual field in his left eye, and left ophthalmoplegia. Serum levels of β-D-glucan were elevated. T1-weighted magnetic resonance imaging with gadolinium enhancement showed hyperintense lesions in the left orbital apex and dura mater of the left middle cranial fossa. A few days later, culture of specimens collected by surgical debridement from the left sphenoidal sinus revealed numerous branching hyphae. The aspergillus antigen was found in the cerebrospinal fluid (CSF). Therefore, aspergillosis causing orbital apex syndrome was diagnosed. Administration of amphotericin B prevented further worsening of the patient's infection. Although noninvasive sinus aspergillosis showed that fungus did not destroy tissues in general, the condition resulted in intracranial impairments observed in this case, including orbital apex syndrome and hypertrophic pachymeningitis. Furthermore, detection of the aspergillus antigen in CSF was a clue for the diagnosis of aspergillosis, and administration of antifungal drugs in the early stages of infection was an effective treatment.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 51 (3), 219-222, 2011

    Societas Neurologica Japonica

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