真菌感染を疑い早期治療により良好な経過を得た眼窩先端症候群の1例

Early treatment was effective in a case of orbital apex syndrome suspected of fungal infection

要約　目的：真菌感染が疑われた眼窩先端症候群に対し，抗真菌薬の投与と副鼻腔手術が奏効した1例の報告。

症例：75歳女性が2か月前からの左眼窩部痛と5日前からの頭痛，羞明，眼瞼下垂，複視で受診した。

所見と経過：視力は右1.2，左0.8で，左眼に動眼神経麻痺の所見があった。MRIで眼窩先端部に異常所見はなく，CTで左上顎洞に真菌感染を示唆する所見があった。真菌性眼窩先端症候群を疑い，ボリコナゾールの点滴と副鼻腔手術を行った。副鼻腔貯留液からアスペルギルス糸状菌が検出された。2週後に複視と眼球運動障害が消失し，視力は0.9に改善した。以後5か月間再発はない。

結論：眼窩先端症候群では，初期の検査結果が陰性でも真菌感染の可能性がある。

Abstract　Purpose: To report a case of orbital apex syndrome in whom early treatment was effective for suspected fungal infection.

Case: A 75-year-old female presented with pain in the left orbit since 2 months before and with photophobia and diplopia since 5 days before.

Findings and Clinical Course: Corrected visual acuity was 1.2 right and 0.8 left. The left eye showed findings of oculomotor palsy. Magnetic resonance imaging（MRI）showed normal findings in the left orbit. Computed tomography（CT）showed findings suggestive of fungal infection in the left paranasal sinus. The findings led to the tentative diagnosis of orbital apex syndrome due to fungus infection. She received voriconaconazole infusion and paranasal surgery. Aspergillus was isolated from the content of paranasal sinus. Diplopia and oculomotor palsy disappeared 2 weeks after surgery. There has been no recurrence for 5 months until present.

Conclusion: The present case illustrates that fungal infection may be present even when initial examination show negative findings.