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.

Human ; Female ; Aged: 65-79 Yrs Old ; Mycoses ; Fungal Infection ; Nasopharyngeal Carcinoma

OBJECTIVE: 1) To describe the effects of intravitreal bevacizumab (IVB) injection for diabetic macular edema (DME) on best-corrected visual acuity (BCVA) and central foveal thickness (CFT) of Filipino patients; 2) To determine correlations between (a) CFT and BCVA, (b) CFT and optical coherence tomography (OCT) patterns of DME, (c) number of injections with BCVA and CFT, (d) number of injections with OCT pattern of DME and the presence of epiretinal membrane (ERM), (e) control and type of diabetes mellitus (DM) with BCVA and CFT;3) To describe ocular and systemic side effects of IVB injections.

METHODS: This was a retrospective non-comparative case series of patients who underwent IVB injection for DME from January 2012 to June 2013. Data gathered included: (1) BCVA, (2) CFT, (3) OCT pattern of DME,(4) presence of ERM on OCT, (5) total number of IVB injections in 12 months, (6) type and control of DM, (7)ocular and systemic side effects of IVB. All analyses were made at the first, third, sixth, and 12th month post-IVB injection.

RESULTS: Sixty-eight eyes received IVB injection, 27 eyes had incomplete data and were excluded, and only 41 eyes were analyzed. There was a consistent improvement in the mean BCVA and decrease in mean CFT from baseline up to the 12th month. There was a steady increase in the mean change in BCVA and a consistent decrease in the percent change in mean CFT until the 12th month. The change in mean BCVA and CFT appeared to have an inverse relationship. Patients who received four or more injections were also those with worse mean BCVA and greater CFT. There was no correlation between the number of injections and the OCT pattern of DME, nor the presence of ERM. The mean BCVA appeared to improve among patients with controlled DM and mean CFT was larger among patients with uncontrolled DM. There were no severe ocular or systemic adverse effects reported.

CONCLUSION: IVB injection resulted in an improvement in the BCVA and a decrease in CFT in patients with DME.No systemic or severe ocular adverse effects were observed. 

Human ; Male ; Female ; Aged ; Middle Aged ; Macular Edema ; Tomography, Optical Coherence ; Epiretinal Membrane ; Bevacizumab ; Retrospective Studies ; Diabetic Retinopathy ; Visual Acuity ; Eye ; Injections