Acute Chiasmal Abscess Resulting from Perineural Extension of Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

作者：Leyngold Ilya^*; Olivi Alessandro; Ishii Masaru; Blitz Ari; Burger Peter; Subramanian Prem S; Gallia Gary

来源：World Neurosurgery, 2014, 81(1): 203.e1.

DOI：10.1016/j.wneu.2013.08.018

• Chiasmal abscess
• Immunocompetent patients
• Invasive sino-orbital aspergillosis
• Perineural extension
• Vision loss

OBJECTIVE: Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient.
CASE DESCRIPTION: A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess.
RESULTS: The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved.
CONCLUSIONS: The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.

• 出版日期2014-1