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Abstract - Invasive orbital aspergillosis in an apparently immunocompetent host without evidence sinusitis
Jennifer Primeggia, George Cyriac, Princy Kumar

 

Invasive aspergillosis is uncommon in healthy individuals. We report a case of Aspergillus fumigatus orbital cellulitis 
with intracranial extension in an apparently immunocompetent patient with a history of benign lymphoid hyperplasia 
of the lacrimal gland. A 68 year-old man with no signiicant past medical history underwent orbitotomy and biopsy of a 
lacrimal gland mass. Pathology showed benign lymphoid hyperplasia of the lacrimal gland and he completed radiation 
therapy. Three months after orbitotomy and one month after completion of radiation therapy, he presented with orbital 
cellulitis. Brain magnetic resonance imaging demonstrated invasion into the frontal lobe. Clinical and radiographic 
indings failed to improve with prolonged antibiotic therapy; transcranial orbitotomy with right frontal craniotomy for 
abscess drainage and orbit washout was performed. Intraoperative cultures grew Aspergillus fumigatus. The patient 
completed a six month course of therapy with oral voriconazole and has remained free from relapse with long-term 
follow-up. Eficacy of voriconazole was guided by serial imaging and voriconazole trough levels. Aspergillus may cause 
invasive disease in immunocompetent hosts, even without evidence of sinusitis, and should be considered in the dif-
ferential diagnosis when patients do not demonstrate clinical improvement with antibiotic therapy. J Microbiol Infect Dis 
2012; 2(3): 113-116
Volume 02, Number 03 (2012)