[abstract]ADJUNCTIVE HYPERBARIC OXYGEN THERAPY FOR TREATMENT OF INVASIVE ASPERGILLOSIS PRESENTING WITH ORBITAL APEX SYNDROME

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[abstract]ADJUNCTIVE HYPERBARIC OXYGEN THERAPY FOR TREATMENT OF INVASIVE ASPERGILLOSIS PRESENTING WITH ORBITAL APEX SYNDROME

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Title: [abstract]ADJUNCTIVE HYPERBARIC OXYGEN THERAPY FOR TREATMENT OF INVASIVE ASPERGILLOSIS PRESENTING WITH ORBITAL APEX SYNDROME
Author: Linden, JA; Karvelas, DA; Dunn, SL; Holm, JR
Abstract: Introduction: Orbital apex syndrome (OAS) involves damage to cranial nerves III, IV, V1, and VI as they pass through the cavernous sinus with optic nerve involvement. Causes include inflammatory, infectious, neoplastic, iatrogenic/traumatic, and vascular conditions. One infectious cause is invasive aspergillosis. These rhinocerebral infections can progress to invasion of the internal carotid artery, sepsis and death. Treatment includes surgical debridement, antifungal drugs and occasionally, adjunctive hyperbaric oxygen (HBO2) therapy. We believe this is the first documented case of aspergillosis in an adult presenting with OAS that was treated with HBO2. Materials and methods: A 67-year-old diabetic female presented with headache, progressing to diplopia with left-sided ptosis and impaired vision. A CT scan showed complete opacification of the left sphenoid sinus. She underwent a partial ethmoidectomy and sphenoidotomy and was treated with empiric antibiotics. Her condition worsened with left eye vision declining to light perception only and complete ophthalmoplegia consistent with OAS. MRI showed extension into the cavernous sinus requiring left orbital apex decompression. Initial debridement tissue cultures grew out aspergillosis, and liposomal amphotericin B was added. She was referred for adjunctive HBO2. Results: The patient was started HBO2 at 2.36 ATA for 90 minutes once to twice a day and treated with IV voriconazole. Although her vision remained unchanged, she has had no further progression of her disease. Conclusions: Invasive aspergillosis presenting as OAS is extremely rare. Standard treatment includes surgical debridement and antifungal therapy. Use of adjunctive HBO2 has been reported for mucormycosis but less commonly for aspergillosis. HBO2 is thought to have some direct antifungal effects as well as correction of the hypoxic environment created by the angioinvasive nature of these infections. It has also been shown to enhance neutrophil and antifungal drug activity. Our case suggests that invasive rhinocerebral infections, especially presenting with OAS, require prompt diagnosis, aggressive debridement, antifungal drugs and consideration of adjunctive HBO2.
Description: Undersea and Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/10501
Date: 2012

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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