Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2014 Jan;81(1):203.e1-6. doi: 10.1016/j.wneu.2013.08.018. Epub 2013 Aug 20.
Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient.
A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess.
The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved.
The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.
颅内侵袭性鼻窦眶曲霉病主要见于免疫功能低下的个体，是一种罕见的疾病。我们报告了一例免疫功能正常的患者，由于鼻窦眶侵袭性曲霉病的神经周围延伸，导致急性视交叉脓肿的独特病例。
一名 61 岁健康的乌克兰男性因严重的左眼眶后疼痛和逐渐同侧单眼视力丧失就诊，视力迅速进展为对侧颞侧视野缺损。发现患者患有颅内侵袭性鼻窦烟曲霉感染，视神经伴有神经周围延伸，并发急性视交叉脓肿。
患者接受了手术清创和辅助抗真菌化疗。患者的生命和视力得以保留。
该病例表明，在免疫功能正常的个体中，通过保留组织的手术和辅助抗真菌化疗，有可能成功控制晚期颅内曲霉病。
