Sinugenic mycotic orbitopathies from the viewpoint of the ENT doctor

Sinugen invasive Aspergillosis with orbital and intracranial progress is very rare, but associated with high mortality rates.

There are important differential diagnoses which should be considered right at the beginning of the diagnostic process.

Methods:

We present singugen invasive Aspergillosis with orbital and intracranial progression and differential diagnoses by means of 3 case reports.

A male 83 yo presents right-sided exophtalmus and positive enhancement intraorbital. Samples show an aspergillosis which was successfully treated with voriconazol. A male 87 yo presents double vision, exophthalmus and loss of vision a year after frontal sinus operation with aspergillom was performed. CT showed an orbital process with intracranial progress. Endonosal extraction was not possible because of severe cardiac diseases. antimykotic therapy was established because of aspergillus positive liquorsample. The patient died of invasive aspergillosis.

A 60 yo female patient presents weeks after surgical aspergillum rehabilitation of the maxillary sinus periorbital pain. CT shows bone destruction of the orbital floor positiv enhancement and meningeal progress. Antimykotic therapy was established, but didn't show recovery. The samplings didn't show mycotic involvement but suspected IgG4 orbithopathy DD polyangitis with granulomatosis. Rheumatologic medication was started.

Conclusion:

Invasive Aspergillosis as well as orbital polyangitis with granulomatosis or IgG4-Orbitopathy are rare but important differential diagnoses. Collaboration with other departments inc ENT, ophthalmology, neurology and rheumatology is essential in the successful diagnosis. Early histology and therapy are essential in the prevention of potential lethal complications.

Publication History

Publication Date:
23 April 2019 (online)