Atypical Optic Neuritis in an Immunocompetent Patient with Orbital

Authors

  • Nurul 'Ain Masnon Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
  • Wan Hazabbah Wan Hitam Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
  • Lakana Kumar Thavaratnam Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Kuala Lumpur, Malaysia
  • Maimunah Abd Munaaim Department of Ophthalmology, School of Medical Sciences, Universiti Sains Islam Malaysia, 71800 Nilai, Negeri Sembilan, Malaysia

DOI:

https://doi.org/10.31436/imjm.v20i4.1729

Keywords:

Aspergillosis, immunocompetent, optic neuropathy, voriconazole

Abstract

Aspergillosis infection in immunocompetent individuals is an uncommon entity. Non-specific presentation could delay in the diagnosis and management. We describe a case of orbital aspergillosis with cavernous sinus extension in a healthy lady. A 67-year-old lady presented with left eye decreased vision, preceded by non-specific headache for three weeks. Visual acuity deteriorated followed by ptosis and left ocular restrictions after corticosteroids therapy. Examination revealed poor left eye visual acuity with ptosis, anisocoria and total ophthalmoplegia. MRI orbit and brain demonstrated a heterogenous left orbital apex lesion extending to cavernous sinus. Transsphenoidal endoscopic biopsy revealed Aspergillus infection at the left retro-orbital space and the sphenoid sinus. Patient was treated with long duration of oral voriconazole. Ptosis and ophthalmoplegia resolved but left optic atrophy remained. In conclusion, orbital aspergillosis may carry a poor visual prognosis and intracranial spread does easily occur. Early treatment may lead to a better outcome in immunocompetent patients.

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Published

2021-10-01

How to Cite

Masnon, N. ’Ain, Wan Hitam, W. H., Thavaratnam, L. K., & Abd Munaaim, M. (2021). Atypical Optic Neuritis in an Immunocompetent Patient with Orbital . IIUM Medical Journal Malaysia, 20(4). https://doi.org/10.31436/imjm.v20i4.1729