Superior Orbital Fissure Syndrome Caused by Indolent Aspergillus Sphenoid Sinusitis

Abstract

Aspergillus fumigatus is the most common fungal pathogen of the paranasal sinuses. Its clinical significance ranges from noninvasive colonization to fulminant invasion of the sinuses and surrounding structures. Immunocompromised individuals are at highest risk for invasive infection. While the maxillary sinus is most commonly affected, isolated sphenoid sinusitis is infrequent. 1 Complications of sphenoid involvement result from extension into contiguous structures such as the orbit, cavernous sinus, or brain. Prompt diagnosis and treatment are paramount to reducing morbidity and mortality. Superior orbital fissure syndrome includes ophthalmoplegia, ptosis, forehead hypesthesia, and retro-orbital pain. Any process that invades the superior orbital fissure may lead to this constellation of findings. We report a case of indolent Aspergillus sphenoid sinusitis presenting as a superior orbital fissure syndrome over a 6-week period. The unusual clinical and radiologic features of this report that led to a delay in diagnosis and treatment are detailed.