Orbital Aspergillosis Mimicking Giant Cell Arteritis
Orbital Aspergillosis or GCA?
Vol. 16 No. 1 : 2021 (262-270)
Abstract
Orbital aspergillosis is a very rare, debilitating disease which can present solely with painful optic neuropathy and mimic giant cell arteritis in an elderly person. We report a case of orbital aspergillosis in a 65-year-old Malay man who presented with unilateral gradual blurring of vision and ipsilateral headache. Our initial working diagnosis was giant cell arteritis. Unfortunately, patient’s condition worsened with intravenous corticosteroid and developed into orbital apex syndrome. Imaging and biopsy results showed evidence of orbital aspergillosis. Patient lost his eyesight due to the wrong initial working diagnosis. This report is to emphasize that although giant cell arteritis is also a sight and life-threatening condition, it is rare among Asian populations. We need to take into account the epidemiology of the disease and look into any other differential diagnoses when the presentation is atypical.
Keywords :
Aspergillosis,
Corticosteroid,
giant cell arteritis,
optic neuropathy,
Correspondance Address
Mae-Lynn Catherine Bastion. Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455981 Email: maelynnbdr@gmail.com
References
Ali, H., Lee, L.N. 2013. Orbital aspergillosis or giant cell arteritis - a diagnostic dilemma. Proceedings of Singapore Healthcare 22(1): 75-80.
Borchers, A.T., Gershwin, M.E. 2012. Autoimmunity reviews giant cell arteritis : a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev 11(6-7): A544-54.
Cahill, K.V., Hogan, C.D., Koletar, S.L., Gersman, M. 1994. Intraorbital injection of amphotericin b for palliative treatment of aspergillus orbital abscess. Ophthalmic Plast Reconstr Surg 10(4): 276-7.
Calvo-Romero, J.M. 2003. Giant cell arteritis. Postgrad Med J 79(935): 511-5.
Chew, S.S., Kerr, N.M., Danesh-Meyer, H.V. 2009. Giant cell arteritis. J Clin Neurosci 16(10): 1263-8.
Choi, J.H., Shin, J.H., Jung, J.H. 2019. Arteritic anterior ischemic optic neuropathy associated with giant-cell arteritis in korean patients: a retrospective single-center analysis and review of the literature. J Clin Neurol 15(3): 386-92.
Denning, D.W., Lee, J.Y., Hostetler, J.S., Pappas, P., Kauffman, C.A., Dewsnup, D.H., Galgiani, J.N., Graybill, J.R., Sugar, A.M., Catanzaro, A., et al. 1994. NIAID mycoses study group multicenter trial of oral itraconazole therapy for invasive aspergillosis. Am J Med 97(2): 135-44.
Hay, R.J. 1994. Liposomal amphotericin B, AmBisome. J Infect 28(suppl 1): 35-43.
Hayreh, S.S. 1990. Anterior ischaemic optic neuropathy differentiation of arteritic from non-arteritic type and its management. Eye 4(1): 25-41.
Hunder, G.G., Bloch, D.A., Michel, B.A., Stevens, M.B., Arend, W.P., Calabrese, L.H., Edworthy, S.M., Fauci, A.S., Leavitt, R.Y., Lie, J.T., et al. 1990. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheumv33(8): 1122-8.
Johnson, T.E., Casiano, R.R., Kronish, J.W., Tse, D.T., Meldrum, M., Chang, W. 1999. Sino-orbital aspergillosis in acquired immunodeficiency syndrome. Arch Ophthalmol 117(1): 57-64.
Kamble, R., Joshi, J., Pendurkar, S. 2015. Paranasal sinus aspergillosis : a case report and review of literature. Inter J Curr Microbiol App Sci 4(9): 314-22.
Levin, L.A., Avery, R., Shore, J.W., Woog, J.J., Baker, A.S. 1996. The spectrum of orbital aspergillosis : a clinicopathological review. Surv Ophthahmol 41(2): 142–54.
Marr, K.A., Boeckh, M., Carter, R.A., Kim, H.W., Corey, L. 2004. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 39(6): 797-802.
Pereira, L.S, Yoon, M.K., Hwang, T.N., Hong, J.E., Ray, K., Porco, T., McCulley, T.J. 2010. Giant cell arteritis in asians: a comparative study. Br J Ophthalmol 95(2): 214-6.
Saedon, H., Saedon, M., Goodyear, S., Papettas, T., Marshall, C. 2012. Temporal artery biopsy for giant cell arteritis : retrospective audit. JRSM Short Rep 3(10): 73.
Serrano Alcalá, E., Grivé Isern, E., Díez Borras, L., Salaya Díaz, J.T. 2020. Orbital magnetic resonance imaging to unmask giant cell arteritis. Radiologia 62(2): 160-3.
Sivak-Callcott, J.A., Livesley, N., Nugent, R.A., Rasmussen, S.L., Saeed, P., Rootman, J. 2004. Localised invasive sino-orbital aspergillosis: characteristic features. Br J Ophthalmol 88(5): 681-7.
Teh, W., Matti, B.S., Marisiddaiah, H., Minamoto, G.Y. 1995. Aspergillus sinusitis in patients with aids : report of three cases and review. Clin Infect Dis 21(3): 529-35.
Zhou, Y., Michael, M.L., Almarzouqi, S.J., Chevez-Barrios, P., Lee, A.G. 2016. Apical orbital aspergillosis complicating giant cell arteritis. J Neuroophthalmol 36(2): 159-63.
