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Shilpy N, Pushker N, Meel R, Agrawal S, Bajaj MS, Sharma S, Thakar A, Satapathy G, Velpandian T. Voriconazole in the treatment of invasive aspergillosis of orbit. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yuan M, Tandon A, Li A, Johnson E, Greer C, Tooley A, Tran AQ, Godfrey KJ, Dinkin M, Oliveira C. Orbital Apex Syndrome Secondary to Invasive Aspergillus Infection: A Case Series and Literature Review. J Neuroophthalmol 2021; 41:e631-e638. [PMID: 33110002 DOI: 10.1097/wno.0000000000001105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive fungal sinusitis carries high morbidity and mortality and often poses a diagnostic challenge. Orbital apex syndrome (OAS) is not an uncommon presentation in the setting of invasive fungal sinusitis. Delays in diagnosis and appropriate treatment can result in permanent visual dysfunction and, potentially, death. We present 2 cases of OAS secondary to invasive sinus aspergillosis, detailing the diagnostic process, treatment, and outcome for both patients. Subsequently, we present a review of the literature and combined analysis of our 2 patients plus 71 cases from previously published reports. METHODS Literature review was performed to identify demographic, diagnostic, clinical, and treatment data of patients with OAS caused by Aspergillus species. RESULTS The review resulted in 52 included articles with 71 patients, plus our 2 reported patients, leading to a total of 73 subjects included in the analysis. The average age of patients at presentation was 59.9 years. A combination of visual disturbance and pain (headache and/or periocular pain) was the most common presentation reported (46 cases; 63%). Diabetes mellitus was reported in 15 cases (21%), with more than half specifically noted to have poorly controlled diabetes. After diabetes, the second most common cause of immunocompromise was chronic steroid use (n = 13; 18%). Empiric antifungal treatment was started in 10 patients (14%), while 25 patients (34%) were first treated with systemic steroids due to a concern for an inflammatory etiology. Time to diagnosis from initial presentation was on average 7.4 weeks (range of 0.3-40 weeks). Approximately 78% of the cases (57 of 73) had biopsies with histology that confirmed Aspergillus fungal morphology, and 30/73 (41%) had diagnostic fungal cultures. The majority of the cases received monotherapy with intravenous (IV) amphotericin B (36 patients; 49%) and IV voriconazole (19 patients; 26%), with a combination of the 2 or more antifungal agents being used in 11 patients (15%). Forty patients (55%) showed signs of clinical improvement with treatment, while 33 (45%) patients did not experience any improvement or continued to deteriorate, and 23 (32%) died in the course of their reported follow-up. CONCLUSIONS The present cases illustrate well the challenge in the diagnosis and treatment of OAS due to invasive sinus aspergillosis. Our review and analysis of 73 cases support the notion that a high index of suspicion leading to early biopsy with histology and fungal culture is paramount for diagnosis. Early empiric antifungal treatment and debridement can potentially reduce morbidity and mortality.
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Affiliation(s)
- Melissa Yuan
- Weill Cornell Medical College (MY, AL), New York, New York; and Department of Ophthalmology (A. Tandon, EJ, CG, A. Tooley, A. Tran, KJG, MD, CO), Weill Cornell Medical College, New York, New York
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Parija S, Banerjee A. Invasive fungal disease misdiagnosed as tumour in association with orbital apex syndrome. BMJ Case Rep 2021; 14:e237626. [PMID: 33472802 PMCID: PMC10577717 DOI: 10.1136/bcr-2020-237626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/29/2022] Open
Abstract
Invasive sino-orbital aspergillosis is a rare cause of orbital apex syndrome (OAS) in immunocompetent patients and often misdiagnosed as tumour because of its aggressive nature and invasive patterns. We report a 23-year-old immunocompetent man presenting with painful progressive loss of vision, ophthalmoplegia and proptosis of the right eye suggestive of OAS. MRI with gadolinium contrast showed an enhancing heterogeneous mass filling the paranasal sinuses, extraconal space and extending up to the right orbital apex. A functional endoscopic biopsy reported as invasive sino-orbital aspergillosis. He was started on intravenous voriconazole and maximal surgical debridement was done. He gradually regained his vision to 20/30 in the right eye. A review of literature reported several such cases which were managed medically or surgically but with poor visual recovery. This case highlights the need for awareness among clinicians for early diagnosis and treatment to prevent vision loss and better survival.
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Affiliation(s)
- Sucheta Parija
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India
| | - Aparajita Banerjee
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India
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Lever M, Wilde B, Pförtner R, Deuschl C, Witzke O, Bertram S, Eckstein A, Rath PM. Orbital aspergillosis: a case report and review of the literature. BMC Ophthalmol 2021; 21:22. [PMID: 33419395 PMCID: PMC7792050 DOI: 10.1186/s12886-020-01773-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background Orbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease. Case presentation A 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously. Conclusions In the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.
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Affiliation(s)
- Mael Lever
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Roman Pförtner
- Department of Oral and Maxillofacial Surgery, Kliniken Essen Mitte, University Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Stefanie Bertram
- Institute of Pathology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Sufi A, Gaikwad N, Shah A, Wani J. Fungal scleritis following evisceration. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_43_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang H, Jiang N, Lin X, Wanggou S, Olson JJ, Li X. Invasive sphenoid sinus aspergillosis mimicking sellar tumor: a report of 4 cases and systematic literature review. Chin Neurosurg J 2020; 6:10. [PMID: 32922939 PMCID: PMC7398181 DOI: 10.1186/s41016-020-00187-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Invasive sphenoid sinus aspergillosis is a rare but life-threatening condition usually found in immunocompromised patients. When involving cavernous sinus and surrounding structures, patients are frequently misdiagnosed with a neoplasm or sellar abscess. Timely diagnosis and intervention are crucial to patients’ outcomes. The objective of this study is to review cases of invasive sphenoid sinus aspergillosis to describe disease manifestations, imaging features, treatment, and outcome. Case presentation We describe four patients with invasive sphenoid sinus aspergillosis misdiagnosed as sellar tumors preoperatively. The mass was completely removed in three patients and partially removed in one patient microscopically. Pathological examinations confirmed Aspergillus in all cases. All four patients received anti-fungal agents postoperatively. There was no recurrence at the time of each patient’s follow-up date. One patient with complete resection was lost to follow-up while the other three patients’ neurologic function improved. Additionally, we performed a systematic review regarding invasive sphenoid sinus aspergillosis of existing English literature. Conclusion With regard to clinical symptoms, headache, vision impairment, and ophthalmoplegia were observed in over half of the patients in the literature. A sellar mass with bone destruction on CT and involvement of cavernous sinus is highly suggestive of invasive fungal sphenoid sinusitis. Immediate surgical removal of the lesion is recommended for invasive sphenoid sinus aspergillosis to preserve nerve function and increase the likelihood of survival.
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Affiliation(s)
- Hanwen Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Nian Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Xuelei Lin
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
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Lee AS, Sullivan TJ. Orbital mycoses in a pediatric subtropical population: a case series. J AAPOS 2019; 23:270.e1-270.e7. [PMID: 31513905 DOI: 10.1016/j.jaapos.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE To report our experience in the diagnosis and management of invasive fungal infections with orbital involvement in children from a subtropical population. METHODS The medical records of children (<18 years of age) with orbital mycosis and treated by the senior author (TJS) from 1995 to 2017 in multiple pediatric tertiary centers were reviewed retrospectively. RESULTS Six patients (aged 12 weeks to 15 years) were included in this series. Four patients had confirmed infection with isolated pathogens, including mucormycosis (3) and Exserohilum (2). One patient rapidly deteriorated and died before biopsy could be performed; however, the patient was presumed to have invasive fungal disease. Four patients had underlying hematological malignancy, and 1 presented in diabetic ketoacidosis. Orbital apex syndrome was observed in one patient. All patients received liposomal amphotericin B and five underwent at least one debridement surgery. One patient proceeded to orbital exenteration and survived. The overall survival rate was 67%. CONCLUSIONS Orbital mycoses can affect children of all ages. Immunocompromised patients are particularly at risk, and mortality rates are high. In a subtropical population, these infections may be caused by a different spectrum of fungi compared to other climate zones. We believe extensive surgical debridement, including exenteration may still be necessary in the management of this disease in a young population, particularly if there is extensive orbital involvement.
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Affiliation(s)
- Allister S Lee
- Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Timothy J Sullivan
- Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Australia; University of Queensland, Brisbane, Australia
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Chang YM, Chang YH, Chien KH, Liang CM, Tai MC, Nieh S, Chen YJ. Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor: A case report and literature review. Medicine (Baltimore) 2018; 97:e11650. [PMID: 30045315 PMCID: PMC6078660 DOI: 10.1097/md.0000000000011650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Orbital apex syndrome is a complex clinical disorder featuring a collection of cranial nerve deficits characterized by impairment of the extraocular muscles, the ophthalmic branch of the trigeminal nerve, and even the optic nerve. Sino-orbital aspergillosis is rare but aggressive infection. Surgical resection accompanied by antifungal medication is advised currently. PATIENT CONCERNS We report a 61-year-old woman diagnosed as aspergilloma presenting with the characteristic manifestations and imaging features of orbital apex syndrome. DIAGNOSES Paranasal sinus tumor was misdiagnosed initially according to magnetic resonance imaging of the orbit. Finally aspergilloma was diagnosed by pathologic report. INTERVENTIONS The anti-fungal medication, voriconazole, was administered immediately. Surgical excision was also done due to the poor response to medical treatment. OUTCOMES Postoperative follow-up showed no recurrence of aspergillosis but the vision was lost permanently. LESSONS Invasive sino-orbital aspergillosis as an aggressive disease with highly invasive patterns and it may be misdiagnosed as tumors. To achieve better prognosis and survival, clinicians should be aware of this distinct manifestation.
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Affiliation(s)
| | | | | | | | | | - Shin Nieh
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Baeesa SS, Bakhaidar M, Ahamed NAB, Madani TA. Invasive Orbital Apex Aspergillosis with Mycotic Aneurysm Formation and Subarachnoid Hemorrhage in Immunocompetent Patients. World Neurosurg 2017; 102:42-48. [PMID: 28254599 DOI: 10.1016/j.wneu.2017.02.096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Invasive orbital apex aspergillosis (IOAA) is an aggressive form of aspergillus infection that usually affects immunocompromised patients. It can cause orbital apex syndrome and, if not treated promptly, may progress rapidly causing fatal complications. Subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysms is a very rare complication of invasive aspergillosis. We aim to describe our management and the outcome of six immunocompetent patients with IOAA with subsequent SAH secondary to ruptured mycotic aneurysms. PATIENTS AND METHODS A retrospective review was undertaken of charts of patients treated for orbital involvement with aspergillosis between January 2003 and December 2015 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. We identified all immunocompetent patients with IOAA who developed vascular complications. RESULTS Six immunocompetent patients with IOAA complicated by SAH secondary to ruptured mycotic aneurysms were identified in the study period. Four patients were female, and patients' age ranged between 14 and 53 years (mean, 33.7 ± 13.4 years). All patients presented with progressive retro-orbital headache, visual impairment, and ophthalmoplegia; four had proptosis. Two patients had vasospasm and brain infarction. Antifungal therapy was used in all patients, and 4 underwent emergency craniotomy and clipping of an aneurysm. Five patients died as a consequence of SAH and infarction. CONCLUSIONS IOAA is a serious disease that commonly causes catastrophic and fatal vascular complications.
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Affiliation(s)
- Saleh S Baeesa
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamad Bakhaidar
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naushad A B Ahamed
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tariq A Madani
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Smith DM, Vossough A, Vorona GA, Beslow LA, Ichord RN, Licht DJ. Pediatric cavernous sinus thrombosis: A case series and review of the literature. Neurology 2015; 85:763-9. [PMID: 26231260 DOI: 10.1212/wnl.0000000000001886] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/06/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature. METHODS Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis. RESULTS Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. CONCLUSION Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed.
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Affiliation(s)
- Douglas M Smith
- From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT.
| | - Arastoo Vossough
- From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT
| | - Gregory A Vorona
- From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT
| | - Lauren A Beslow
- From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT
| | - Rebecca N Ichord
- From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT
| | - Daniel J Licht
- From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT
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Peregud-Pogorzelski J, Wawrykow P, Wozniak S, Zakowska A, Brodkiewicz A. Highly effective unconventional management of aspergillosis of the left maxillary sinus in an 11-year-old girl with rhabdomyosarcoma embryonale of the frontal sinus. J Med Microbiol 2012; 62:652-654. [PMID: 23242643 DOI: 10.1099/jmm.0.044222-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Invasive fungal infections are common causes of death in children treated for malignancies, and therefore present an important and growing clinical problem. Fungal invasion usually affects immunocompromised patients, but increased incidences are also associated with intensification of antineoplastic therapy and increased numbers of organ and bone marrow transplantations. Fungal infections in parameningeal and cerebral locations carry high risks of treatment failure. We describe the case of an 11-year-old female patient with rhabdomyosarcoma embryonale of the frontal sinuses with metastases to the neck lymph nodes, treated according to the CWS 2002 protocol for high-risk patients. Left maxillary sinus aspergillosis was diagnosed during chemotherapy following radiotherapy, and 56 days after surgical excision of the tumour. No effect was achieved by use of amphotericin B. Further treatment included intravenous voriconazole at 6 mg per kg body weight every 12 h for 2 weeks, followed by oral voriconazole at 4 mg per kg body weight twice daily for 6 months. Simultaneous excision of necrotic tissues from the nasal cavity, ethmoid bone, maxillary sinus and frontal recess was performed. The sinus was kept open for 3 weeks to allow voriconazole lavage every 12 h for 3 weeks. This unconventional treatment resulted in eradication of sinus aspergillosis and allowed intensive chemotherapy to be continued with no recurrence of aspergillosis.
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Affiliation(s)
| | - Pawel Wawrykow
- Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Sebastian Wozniak
- Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Anna Zakowska
- Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Brodkiewicz
- Department of Pediatrics, Pediatric Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
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Ohlstein DH, Hooten C, Perez J, Clark CL, Samy H. Orbital aspergillosis: voriconazole - the new standard treatment? Case Rep Ophthalmol 2012; 3:46-53. [PMID: 22611368 PMCID: PMC3355651 DOI: 10.1159/000336276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background/Aim To describe a case of invasive orbital aspergillosis and evaluate treatments and outcomes. Methods A case report and review of orbital aspergillosis treatment with voriconazole in the English language literature. Conclusion Amphotericin B with debridement is the current standard of care for orbital aspergillosis; however, its prognosis is unfavorable. When compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerated by patients. While a prospective trial comparing amphotericin B to voriconazole in orbital aspergillosis is not feasible, there is evidence to support the use of voriconazole as primary therapy.
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Affiliation(s)
- Derek H Ohlstein
- Neuro-Ophthalmology Service, Department of Ophthalmology, University of Florida, Gainesville, Fla., USA
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