Two cases of invasive fungal sinusitis showing orbital apex syndrome

Abstract

Invasive fungal sinusitis has a poor prognosis and intracranial spread is often fatal. We report two cases of invasive fungal sinusitis showing orbital apex syndrome.
Case 1: An 80-year-old woman resulted in a fatal outcome due to rupture of a cerebral aneurysm. She had been treated with steroids for four months before receiving an accurate diagnosis by endoscopic sinus surgery (ESS).
Case 2: An 84-year-old man received ESS for the diagnosis after one month of treatment with steroids, and improved by treatment with Voliconazol.
The differential diagnosis of orbital apex syndrome is generally difficult because the biopsy is highly invasive. However, the development of ESS enables diagnosis with a minimally invasive procedure. Early and appropriate biopsy using ESS to obtain an accurate diagnosis is important for improving the prognosis of invasive fungal sinusitis.