Dr.SARITA BERI, B06053
A 24 year male presented with features suggestive of retrobulbar neuritis in his right eye (RE). Neuroimaging revealed right optic nerve edema. Treatment with high dose (one gram/day) of intravenous methylprednisolone (IVMP) followed by oral steroids restored vision. However, in the following two weeks despite another high dose of IVMP, steroids and IV antibiotics, he showed features of orbital cellulitis and became PL negative in this eye. Prompt imaging suggested ethmoidal sinusitis with orbital cellulitis.Functional endoscopic sinus surgery demonstrated yellowish debris in ethmoidal sinus and Aspergillus flavus grew on culture. Treatment with oral steroids under the cover of I.V Amphotericin B for 44 days improved visual acuity to 6/12 with partial optic atrophy. Early diagnosis of aspergillosis in immunocompetant patients presenting with sudden onset visual loss mimicking optic neuritis is challenging.
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