Rare case of extensive aspergillosis of nose and paranasal sinuses with sinking orbit

Abstract

: Aspergillus species is a chronic colonizer of paranasal sinuses and ears as well as associated with a variety of different clinical conditions. Fungi are increasingly recognized as a significant cause of morbidity and mortality among the patients because of the wider use of broad-spectrum antibiotics, immuno suppressive therapy, cancer chemotherapy, increased incidence of immunodeficiency diseases and increased use of intensive care interventions. Among the species of Aspergillus, A. flavus is more common in India and Arabian countries while in USA A. fumigatus is the most common32 years old male presented with complaints of headache since 4 months, insidious in onset, progressive, no history of diurnal variation. He developed swelling around right eye since 3 months associated with history of diplopia. He was non diabetic but was hypertensive& was on medication. Ge was suffering from Rheumatoid Arthritis and on immunosuppressive medications for it. CT scan of nose & paranasal sinuses revealed a soft tissue opacification in the right maxillary sinus with right anterior ethmoids and extensive bony erosion of the sinuses and the floor of orbit with intraorbital extension. The eyeball was sinking in the maxillary sinus. Patient was taken up for surgery , Right Total Maxillectomy Surgery with repair of floor of orbit using Titanium plate was done under under general anaethesia using External Weber Ferguson approach. Intraoperative findings suggestive of fungal debris in Right maxilla which was confirmed on final histopathological report.: Invasive aspergillosis is mainly seen in immunocompromised individuals likeneutropenia, uncontrolled Diabetes Mellitus, inappropriate use of antibiotics, immunosuppressive drugs and corticosteroids, post viral infections. The mortality and morbidity like vision loss, facial deformity, meningitis,and other intracranial complications can be reduced with early recognition and early intervention. The advanced tools like Titanium plates can prevent the sinking of eyeball into maxillary Sinus & prevent morbidities like diplopia, squint & vision loss. Aspergillosis of Nose & Paranasal sinus; Sinking Orbit