Orbital Apex Syndrome secondary to Chronic Invasive Fungal Rhinosinusitis and its Diagnostic Challenges: A Case Report

Abstract

Objective: To present a case of chronic invasive infection rhinosinusitis (CIFRS) complicated by orbital apex syndrome, highlighting the significant diagnostic challenges and delays encountered before establishing the diagnosis.

Methods: This is a case report.

Case Presentation: This patient is a 65-year-old diabetic female, status post-kidney transplantation with immunosuppressant use presented with headache and sudden painless vision loss and extraocular limitation of the right eye. Magnetic resonance imaging (MRI) revealed a right-sided ill-defined nasopharyngeal mass, with nasopharyngeal carcinoma as the radiologic consideration. Biopsy revealed bacterial and fungal elements. During admission, antibiotics, antifungals, and tumor debulking was done but symptoms persisted. Histopathology showed reactive inflammatory tissue; hence, a short course of intravenous high-dose steroids was given. Overall health declined and patient eventually expired.

Conclusion: This case highlights the importance of maintaining high clinical suspicion for fungal infection despite non-specific radiologic findings in immunocompromised patients with vague, localized symptoms. Prompt recognition and tissue diagnosis are critical for early intervention.