Zhang Kevin X, Gu David, Puchi Christopher, Welch Kevin C, Lissner Gary S
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
Am J Ophthalmol Case Rep. 2023 Jul 20;32:101903. doi: 10.1016/j.ajoc.2023.101903. eCollection 2023 Dec.
To report a case of acute rhino-orbital-cerebral aspergillosis with aggressive intracranial and orbital extension co-managed medically and surgically with endoscopic sinus debridement and multiple retrobulbar injections of amphotericin B.
A 70-year-old male patient presented via external transfer with headaches and left ophthalmoplegia concerning for severe complicated sinusitis with intracranial and left orbital spread. His history is notable for a simultaneous heart-kidney transplant three years prior on chronic immunosuppression. Ophthalmologic examination revealed complete ophthalmoplegia in the left eye with no light perception concerning for a left orbital apex syndrome. The patient was taken to the operating room twice for endoscopic sinus debridement and three separate retrobulbar injections of amphotericin B. Fungal cultures from surgical specimens grew isolated . Patient's symptoms gradually improved and repeat MRI demonstrated resolution of pansinusitis, sparing left eye exenteration.
Multidisciplinary management of invasive fungal rhinosinusitis in the setting of profound immunosuppression poses a significant challenge. While surgical debridement remains the cornerstone approach, the achievable reduction in disease burden may be augmented by targeted retrobulbar antimicrobials.
报告一例急性鼻眶脑曲霉病，伴有侵袭性颅内和眶内扩展，通过内镜鼻窦清创术和多次球后注射两性霉素B进行药物和手术联合治疗。
一名70岁男性患者通过外部转诊前来就诊，主诉头痛和左眼球麻痹，怀疑为伴有颅内和左眶蔓延的严重复杂性鼻窦炎。值得注意的是，他在三年前同时接受了心脏-肾脏移植，目前正在接受慢性免疫抑制治疗。眼科检查发现左眼完全性眼球麻痹，无光感，符合左眶尖综合征。该患者接受了两次内镜鼻窦清创术和三次单独的球后注射两性霉素B。手术标本的真菌培养分离出[具体真菌名称未给出]。患者症状逐渐改善，复查磁共振成像显示全鼻窦炎消退，避免了左眼眼球摘除术。
在深度免疫抑制情况下，侵袭性真菌性鼻窦炎的多学科管理面临重大挑战。虽然手术清创仍然是主要治疗方法，但通过有针对性的球后抗菌药物治疗，可进一步减轻疾病负担。
