Sino-orbital aspergillosis in acquired immunodeficiency syndrome.
Arch Ophthalmol
; 117(1): 57-64, 1999 Jan.
Article
in En
| MEDLINE
| ID: mdl-9930161
ABSTRACT
OBJECTIVE:
To describe the clinical features, causes, imaging characteristics, treatment, and outcome of patients with the acquired immunodeficiency syndrome (AIDS) and sino-orbital aspergillosis.DESIGN:
Records of 5 patients were reviewed. Results of imaging and histopathologic examinations and clinical courses of the patients were studied.RESULTS:
There were 3 women and 2 men (mean age, 34.0 years). All had received a diagnosis of AIDS, and mean CD4+ cell count was 0.014 x 10(9)/L (14 cells/mm3). Computed tomographic scanning exhibited heterogeneous, enhancing sino-orbital soft tissue lesions with bony erosion, and magnetic resonance imaging disclosed soft tissue masses hypointense on T1- and T2-weighted images. The infection involved 1 or more paranasal sinuses, with extension into the right orbit in 3 patients and into the left orbit in 2. Patients were treated with aggressive surgical debridement and intravenous antifungal agents. In addition, local irrigation of amphotericin B was performed in 3 patients. Aspergillus fumigatus was found to be the cause in all 5 patients. Intracranial extension developed in 4 patients, and all subsequently died. The 2 longest surviving patients were the only ones being treated with protease inhibitors. Three patients had a history of frequent marijuana smoking.CONCLUSIONS:
Sino-orbital aspergillosis is a progressive, relentless, and usually fatal opportunistic infection of advanced AIDS. Patients are first seen with long-standing headache and proptosis with minimal external inflammatory signs. Marijuana smoking may increase the risk for development of sino-orbital aspergillosis in these patients. Aggressive surgical and medical treatment, combined with newer combination therapies using protease inhibitors, may improve the longevity of these patients.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Orbital Diseases
/
Paranasal Sinus Diseases
/
Aspergillosis
/
Eye Infections, Fungal
/
AIDS-Related Opportunistic Infections
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Language:
En
Journal:
Arch Ophthalmol
Year:
1999
Document type:
Article
Affiliation country:
United States