SHM Converge Scientific Abstract ePoster Gallery-When Sinusitis Steals Sight: Aspergillus- Staphylococcus Lugdunensis Co-Infection in Poorly Controlled Diabetes

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This case report describes a rare and severe infection causing sudden right eye vision loss in a 67-year-old man with poorly controlled type 2 diabetes. Imaging showed extensive sinus disease involving the sphenoid sinuses with extension to the orbital apex and bony erosion, raising concern for invasive sino-orbital disease. Nasal endoscopy and biopsy confirmed invasive fungal sinusitis.<br /><br />Surgical cultures identified two Aspergillus species along with Staphylococcus lugdunensis, an unusually aggressive bacterial co-infection. The patient underwent urgent, multidisciplinary treatment including bilateral sphenoidotomy, ethmoidectomy, orbital decompression, and retrobulbar amphotericin injections. He also received systemic antifungal therapy with amphotericin B and voriconazole, plus IV antibiotics including nafcillin and metronidazole. Treatment was complicated by nephrotoxicity and liver dysfunction.<br /><br />Despite prompt and aggressive management, the patient’s right-eye vision did not recover, although some extraocular movement returned. The report emphasizes that invasive sino-orbital aspergillosis is an angioinvasive infection that can rapidly destroy tissue and threaten vision, especially in patients with uncontrolled diabetes. The added presence of S. lugdunensis likely worsened disease severity.<br /><br />The key message is that clinicians should maintain a high index of suspicion for invasive fungal sinusitis in diabetic patients with sinusitis and early orbital symptoms. Early imaging, histopathology, surgical debridement, and coordinated care among ENT, infectious disease, ophthalmology, and radiology are essential to prevent blindness and intracranial spread.

Asset Subtitle

Zarlin Khan

Meta Tag

Author List Katharine S. Dempsey, Marcia Epstein, Vlad S. Shusterman, Zarlin Khan

Category Clinical Vignettes

Concept Invasive Sino-Orbital Aspergillosis

Concept Vision Loss

Concept Invasive Fungal Sinusitis

Concept Biopsy

Concept Surgical Debridement

Distinguished Non-Finalist

Presenter Organization Herricks High School

Presenting Author Zarlin Khan

Track Adult

Keywords

invasive fungal sinusitis

sino-orbital aspergillosis

vision loss

poorly controlled diabetes

orbital apex

sphenoid sinusitis

Aspergillus species

Staphylococcus lugdunensis

amphotericin B

surgical debridement

Invasive Sino-Orbital Aspergillosis

Vision Loss

Invasive Fungal Sinusitis

Biopsy

Surgical Debridement