Choi Mi Young, Bae Il Hun, Lee Jong Hoon, Lee Seong Jun
Department of Ophthalmology, College of Medicine, Chungbuk National University & Chungbuk National University Medical Research Institute, Cheongju, Korea.
Korean J Ophthalmol. 2002 Dec;16(2):119-23. doi: 10.3341/kjo.2002.16.2.119.
A 59-year-old woman was referred to our clinic with sudden visual loss in her right eye after she was treated with 40 mg/day of oral prednisolone for 2 weeks under the diagnosis of idiopathic optic neuritis. At that time, computerized tomography (CT) of the brain showed no evidence of optic nerve or brain pathology. However, there was progressive diminution of right visual acuity associated with a limitation of adduction and abduction in the right eye. On magnetic resonance imaging and repeated CT, a malignant lesion was suggested, and was confirmed as an Aspergillus fungus colony by histopathologic examination. Postoperatively, she was treated with intravenous administration of amphotericin B for 13 weeks. However, her condition continued to deteriorate. She developed ptosis and total ophthalmoplegia in the right eye and blindness in both eyes. After discharge, she was given itraconazole for 20 weeks. She has shown no recovery of visual acuity or extraocular motion during a two-year follow-up period. The clinical features of our case suggest that early diagnosis in a case of aspergilloma presenting with visual loss is difficult and that a high index of suspicion, repeated radiological examination and adequate biopsy may be required for diagnosis.
一名59岁女性在被诊断为特发性视神经炎后，接受了为期2周、每日40毫克口服泼尼松龙的治疗，之后右眼突然失明，遂被转诊至我院门诊。当时，脑部计算机断层扫描（CT）未显示视神经或脑部病变的迹象。然而，右眼视力逐渐下降，并伴有右眼内收和外展受限。磁共振成像和重复CT检查提示有恶性病变，经组织病理学检查确诊为曲霉菌菌落。术后，她接受了为期13周的静脉注射两性霉素B治疗。然而，她的病情仍持续恶化。她出现了右眼上睑下垂和完全性眼肌麻痹，双眼失明。出院后，她接受了20周的伊曲康唑治疗。在两年的随访期内，她的视力和眼球运动均未恢复。我们病例的临床特征表明，以视力丧失为表现的曲霉菌瘤病例早期诊断困难，诊断可能需要高度怀疑、重复的影像学检查和充分的活检。
