Orbital Aspergillosis In Systemic Lupus Erythemarosus Patient

1. Arini Safira
2. Rossalyn Sandra Andrisa
3. Neni Anggraini

Ophthalmology Department, Faculty of Medicine University of Indonesia, Jakarta, Indonesia

Purpose: to report a case of orbital aspergillosis in a systemic lupus erythematosus (SLE) patient.

Methods: a case report. A 20-year-old female presented with proptosis accompanied with painful ophthalmoplegia of the left eye since 9 months ago. The patient also suffered from SLE since 4 years ago and had been receiving methylprednisolone and mycophenolate mofetil. The ophthalmological examination found visual acuity of the left eye was light perception and oedema of the optic nerve head (ONH). There was also 4 mm proptosis and restricted movement. The CT scan examination revealed a mass on the left orbital apex with thickening of the mucosa of the roof of the paranasal sinuses with parasellar infiltration. Biopsy of the mass confirmed aspergillosis with sensitivity to voriconazole. The patient was then treated with oral voriconazole 2x200 mg.

Results: after administration of voriconazole, the general condition, pain and proptosis resolved gradually. The visual acuity was deteriorated to no light perception with atrophy of the ONH. There was reduction of the retrobulbar mass according to CT scan examination.

Conclusion: orbital aspergillosis can occur as invasive infection from the paranasal sinuses in immunocompromised patient. Invasive extension of the infection to orbital region can be presented as progressive painful exophthalmos and could lead to intracranial infiltration. Management of orbital aspergillosis consists of radical debridement and antifungal therapy. In this case we managed to avoid exenteration. Voriconazole in this patient had resulted on improvement of the symptoms and reduction of the mass despite the immunosuppressive condition of the patient.