Cephalgia and diplopia - a rare differential diagnosis

Introduction While aspergilloma is a relatively common and well curable disease, severe invasive aspergillosis is rather rare in the paranasal sinuses. Nevertheless, an early recognition of the same is of highest importance due to the prognosis and the therapeutic consequences.

Methods Over a period of 12 months we can report on 3 cases of invasive aspergillosis. A 78-year-old patient presented with double vision in the right eye. The MRI showed a retroorbital tissue proliferation with obvious contrast medium uptake. The suspected Tolosa-Hunt-Syndrome was treated with Prednisolon over a period of 2 months. Since there was no improvement and the patient turned blind on the right eye, a transsphenoidal biopsy was taken from the optic nerve to ensure the correct diagnosis. The CT of an 83-year-old patient with cephalgia showed a complete obstruction of the right paranasal sinus with osseous dehiscence of the ethmoid sinus. The MRI showed a suspected intracranial empyema, which consequently was treated with a transethmoidal and transfrontal surgery during which the abscesses were opened. In the third case, a biopsy was taken from the right sphenoidal sinus of a patient with myelodysplastic syndrome. After the confirmation of the diagnosis, the therapy of choice is the intravenous administration of voriconazol. Contrary to mucormycosis, a surgical infectious source control, not a radical surgery, is necessary. Nevertheless, the last patient died due to intracranial complications.

Conclusion Despite the rareness of an invasive aspergillosis, attention must be paid to elderly, immunocompromised patients. A quick biopsy to ensure the diagnosis is important to start an intravenous antimycotic therapy and to avoid complications.

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Publication History

Article published online:
07 August 2020