Invasive Aspergillome of the Orbit – a rare differential diagnosis of orbital tumors

Introduction:

The etiology of orbital tumors is manifold and varies significantly. Sinuorbital aspergillosis is a rare disease. However, I can have a severe course in immuno-compromised patients. The clinical characteristics and therapy oft wo cases is presented.

Case reports

1 – An 81-year old patient with myelodysplastic syndrome (MDS) was admitted to the hospital with an orbital tumor of unknown cause. An invasive aspergillome was histologically confirmed on tissue specimens which were obtained during endonasal median orbitotomy. An antimycotic therapy with voriconazole was initiated, the aspergillome was surgically excised. Consecutively the patient presented a massive recurrence so that an orbital exenteration was necessary. The patient survived and is to date free of disease.

2 – A 76-year old patient with atypic MDS was admitted to the hospital with a tumor of the right orbit. A transnasal sphenoidotomy and transpalpebral decompression of the orbit was performed. Histologically an invasive aspergilloma was verified. During surgery and also proved by CT scans an intracranial invasion of the aspergillome was indicated so that there was no realistic option for a complete surgical excision. An intravenous treatment with voriconazole was initiated. Postoperatively the patient developed a severe pneumonia and a delirium. General state and vigilance decreased dramatically. The patient moved to a palliative care unit and finally died shortly after.

Conclucions:

Invasive aspergillosis is a rare differential diagnosis of an orbital tumor occurring in particular in immune-depressed patients. An early and radical surgical and drug treatment is mandatory along with a general improvement of the immune system. Nevertheless this disease is frequently devastating.

Publication History

Publication Date:
23 April 2019 (online)