A case of optic neuropathy secondary to noninvasive Aspergillus infection of the paranasal sinus Tatsuaki Amari 1 , Hiromasa Sawamura 2 , Risa Minamidate 2 , Makoto Aihara 2 1Eguchi Eye Hospital 2Department of Ophthalmology, The University of Tokyo Hospital pp.907-912
Published Date 2020/7/15
DOI https://doi.org/10.11477/mf.1410213624
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Abstract Purpose:To report a case of optic neuropathy due to paranasal Aspergillus infection with no typical findings in the blood or diagnostic imaging.

Case:A 64-year-old male presented with blurred vision in the left eye since 10 days before. He had been suffering from diabetes mellitus and had episodes of brain infarct.

Findings and Clinical Course:Corrected visual acuity was 1.2 right and 0.02 left. The left eye showed mild disc swelling and relative afferent pupillary defect. Eye movement was normal. Contrast-enhanced MRI showed thickened mucosa of the sphenoid sinus and no enhancement in the optic nerve. Blood tests showed normal findings including β-D-glucan, suggesting that fungus infection is not likely. He was treated by pulsed corticosteroid. Clinical findings initially improved and then deteriorated. MRI showed thickened bone cortex of the sphenoid sinus with spreading of inflammation into the left optic nerve. Paranasal sinus biopsy showed Aspergillus mass in the upper part of paranasal sinus, leading to the diagnosis of orbital tip syndrome due to sinus aspergillosis.

Conclusion:The present case is considered to be a noninvasive type of sinus aspergillosis. Sinus biopsy was useful in the diagnosis.

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