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Invasive fungal disease misdiagnosed as tumour in association with orbital apex syndrome
  1. Sucheta Parija and
  2. Aparajita Banerjee
  1. Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India
  1. Correspondence to Dr Sucheta Parija; suchetaparija{at}


Invasive sino-orbital aspergillosis is a rare cause of orbital apex syndrome (OAS) in immunocompetent patients and often misdiagnosed as tumour because of its aggressive nature and invasive patterns. We report a 23-year-old immunocompetent man presenting with painful progressive loss of vision, ophthalmoplegia and proptosis of the right eye suggestive of OAS. MRI with gadolinium contrast showed an enhancing heterogeneous mass filling the paranasal sinuses, extraconal space and extending up to the right orbital apex. A functional endoscopic biopsy reported as invasive sino-orbital aspergillosis. He was started on intravenous voriconazole and maximal surgical debridement was done. He gradually regained his vision to 20/30 in the right eye. A review of literature reported several such cases which were managed medically or surgically but with poor visual recovery. This case highlights the need for awareness among clinicians for early diagnosis and treatment to prevent vision loss and better survival.

  • visual pathway
  • cranial nerves
  • pupil
  • otolaryngology / ENT

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  • Contributors SP contributed to the concept, design, intellectual content, manuscript preparation, editing and reviewing. AB contributed to the design, literature search, manuscript preparation and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.