Alkharashi Abdulmajeed S, Yaseen Ali, Alkatan Hind M, Diab Mostafa M, Alsuhaibani Adel H
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Ophthalmology, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Orbit. 2025 Oct;44(5):638-642. doi: 10.1080/01676830.2025.2481930. Epub 2025 Mar 26.
Orbital aspergillosis is a rare but potentially life- and sight-threatening fungal infection that can affect both immunocompromised and healthy individuals. We present a case of orbital aspergillosis with infraorbital nerve enlargement in a healthy 30-year-old male who presented with progressive proptosis, diplopia, and vision decline. Nasal endoscopy was unremarkable. CT imaging revealed an ill-defined, infiltrative, hyperdense mass in the left inferior orbital region with presumed enlargement of the infraorbital nerve (ION) and expansion of the ION canal, along with pterygopalatine fossa involvement, while the sinuses were almost clear. MRI showed similar findings. Histopathological analysis confirmed . Treatment with voriconazole led to significant clinical improvement. This case underscores the diagnostic challenges of orbital aspergillosis and highlights that ION enlargement should be cautiously interpreted as a specific sign of IgG4-related disease. It is crucial to maintain a high index of suspicion in cases of progressive proptosis, even in the absence of clear sinonasal involvement.
眼眶曲霉病是一种罕见但可能危及生命和视力的真菌感染，可影响免疫功能低下者和健康个体。我们报告一例健康30岁男性眼眶曲霉病伴眶下神经增粗的病例，该患者表现为进行性眼球突出、复视和视力下降。鼻内镜检查未见异常。CT成像显示左眼眶下区域有一个边界不清、浸润性、高密度肿块，推测眶下神经（ION）增粗且ION管扩张，翼腭窝受累，而鼻窦几乎清晰。MRI显示类似结果。组织病理学分析证实了诊断。伏立康唑治疗使临床症状显著改善。该病例强调了眼眶曲霉病的诊断挑战，并突出表明ION增粗应谨慎解释为IgG4相关疾病的特定体征。即使在没有明确鼻窦受累的情况下，对于进行性眼球突出的病例保持高度怀疑指数至关重要。
