Angioinvasive aspergillosis mimicking giant cell arteritis in an 81-year-old man with jaw pain and vision loss.
Romain GuemaraAmara PierenLaure BrulhartPublished in: RMD open (2022)
The present case report focuses on an immunocompromised 81-year-old patient initially diagnosed with Waldenström's disease. The patient experienced a gradual vision loss and jaw pain with high erythrocyte sedimentation rate. We first suspected giant cell arteritis, despite inconclusive assessment, including a negative temporal artery biopsy. We rapidly started a corticosteroid pulse therapy followed by high-dose corticosteroid therapy that was followed even after discharge from the hospital. The patient was readmitted 20 days later with severe left retro-orbital pain and progressive left vision loss. Clinical examination revealed complete left eyelid ptosis and unilateral blindness with fixed mydriasis and no eye movement. MRI showed signs of ischaemic optic neuropathy with lysis of the left ethmoid sinus wall; thus, indicating ischaemic optic neuropathy related to lymphoplasmacytic infiltration of Waldenström's disease (Bing-Neel syndrome). Oncological treatment of ibrutinib, a tyrosine kinase inhibitor, was then administered. Despite a favourable prognosis, no improvement was seen. An infectious aetiology was finally confirmed. The left sphenoid sinus biopsy highlighted an angioinvasive aspergillosis with rhino-orbital infiltration observed as ischaemic optic neuropathy. Oncologic treatment was discontinued and antifungal therapy with voriconazole was introduced, leading to a favourable radiological development and analgesic control, without ophtalmological improvement.
Keyphrases
- case report
- giant cell
- chronic pain
- neuropathic pain
- pain management
- high dose
- magnetic resonance imaging
- healthcare
- blood pressure
- rectal cancer
- multiple sclerosis
- low dose
- ultrasound guided
- stem cells
- magnetic resonance
- spinal cord
- early onset
- replacement therapy
- contrast enhanced
- robot assisted
- bone marrow
- candida albicans
- extracorporeal membrane oxygenation
- postoperative pain
- anti inflammatory
- minimally invasive
- computed tomography
- clinical evaluation