Orbital apex syndrome caused by Alternaria species: A novel invasive fungus and new treatment paradigm

ABSTRACT

Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences. Mucormycosis and Aspergillus species are the most common causes of such infections. Alternaria fungal sinusitis is a known entity, but its ability to cause an orbital apex syndrome has not yet been reported. Here, we present a case of orbital apex syndrome in an immunocompromised patient with invasive fungal sinusitis caused by Alternaria species. The patient underwent sinus washout and placement of an intraorbital catheter for local instillation of amphotericin B for 10 days, in addition to systemic antifungal treatment, with clinical resolution of infection. The use of an intraorbital catheter for local treatment of fungal infection may offer an exenteration-sparing treatment option in these patients.

KEYWORDS:

• Alternaria
• amphotericin B
• intraorbital catheter
• invasive fungal sinusitis
• orbital apex syndrome

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

This work was partially supported by an unrestricted departmental grant from Research to Prevent Blindness, New York, New York to Vanderbilt Eye Institute, Department of Ophthalmology.