A Renal Transplant Recipient With Orbital Apex Syndrome Due to Invasive Aspergillosis

A Turkish patient was evaluated because of loss of vision of the left eye at the second month after renal transplantation. The ophtalmologic examination showed the involvement of IIIrd, IVth and VIth cranial nerves and orbital apex syndrome was diagnosed. Further investigations showed the presence of acute inflammation in left ethmoid and sphenoid paranasal sinuses. The results of the paranasal sinus endoscopy and pathological examination of the punch biopsies were consistent with invasive aspergillosis sinusitis. Cranial and orbital magnetic resonance images showed orbital sellulitis with the involvement of orbital apex. There was also cavernous sinus thrombosis and thrombosis of internal carotid arteria. The patient was treated with liposomal amphothericin B for 56 days and with itraconazole 200 mg/day for the maintenance therapy. A significant regression of the invasive sinusitis was achieved with this therapy. The patient is now on haemodialysis with good health.