International Journal of Otorhinolaryngology and Head and Neck Surgery | November 2020 | Vol 6 | Issue 11 Page 2135 International Journal of Otorhinolaryngology and Head and Neck Surgery Phogat J et al. Int J Otorhinolaryngol Head Neck Surg. 2020 Nov;6(11):2135-2138 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 Case Report Sino-orbito-cerebral aspergillosis in an immunocompetent patient: a rare case report Jitender Phogat 1 , Manisha Nada 1 *, Monika Dahiya 1 , Sneha Solanki 2 INTRODUCTION Fungi are an important opportunistic pathogen in immunocompromised individuals, which is very well documented in literature. 1-3 But, invasive sino-orbital fungal infections are uncommon in immunocompetent patients, whose diagnosis and treatment still remains a challenge. Sino-orbito-cerebral aspergillosis in healthy immunocompetent individuals is a relatively under- diagnosed and under-recognised clinical entity. Most common source of infection for aspergillosis is paranasal sinuses, most common being the maxillary sinus, followed by ethmoid, sphenoid and frontal sinus. Most common site of involvement is lung but invasive forms can also present as rhinosinusitis. 4 Infection can spread from the adjacent paranasal sinuses to orbit by breaching the lamina papyracea and can spread to the brain via optic nerve, making the prognosis even worse. 5,6 Here, we present a case of invasive sino-orbito-cerebral aspergillosis in an immunocompetent patient, which is rare clinical entity and often not suspected because there are numerous orbital pathologies which can present in a similar fashion. Till date, there are no standard guidelines for its treatment and outcome is poor if not diagnosed and treated timely as it can spread to middle cranial fossa via ABSTRACT Invasive sino-orbito-cerebral aspergillosis is rarely seen in immunocompetent individuals; diagnosis and management of which is still a challenge. We report a case of invasive sino-orbito-cerebral aspergillosis in a 38 year immunocompetent male presenting with mild protrusion of right eye which was associated with no other complaint. His visual acuity was 6/6 in both eyes. There was mild proptosis of right eye of 2 mm on Hertel exophthalmometer with no restriction of the ocular movements. MRI brain, orbit and paranasal sinuses revealed soft tissue swelling in right ethmoid, frontal and sphenoidal air cells and orbit with bony destruction of lamina papyracea with intracranial extension of the mass with destruction of lamina cribrosa. The tissue biopsy was taken from the uncinate process and middle turbinate and sent for histopathological examination which revealed a fibrocollagenous soft tissue which was densely infiltrated by inflammatory cells with presence of large number of foreign body granulomas and filamentous aspergillus fungal hyphae. By radiological and histopathological findings, patient was diagnosed as a case of rhino- orbito-cerebral aspergillosis and given Tb Voriconazole 200 mg BD for 6 months after neurosurgery consultation. His proptosis was revealed at 3 months and repeat MRI showed slightly thickened mucosa of sinuses with no mass lesion seen in the orbit and brain with no evidence of any residual fungal granuloma. Orbital aspergillosis is quite challenging in terms of both diagnosis and treatment. Prolonged antifungal therapy is very effective in controlling infection, if patient is compliant. Keywords: Aspergillosis, Fungal infections, Proptosis, Voriconazole. 1 Regional Institute of Opthalmology, PGIMS, Rohtak, Haryana, India 2 ESIC Model Hospital, Gurugram, Haryana, India Received: 07 September 2020 Accepted: 14 October 2020 *Correspondence: Dr. Manisha Nada, E-mail: manisha_nada@rediffmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20204647