• Journal of Yeungnam Medical Science
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• v.24 no.1
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• pp.79-84
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• 2007

Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.

• Archives of Craniofacial Surgery
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• v.25 no.1
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• pp.27-30
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• 2024

Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters' view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino-orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

• Journal of Veterinary Clinics
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• v.23 no.4
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• pp.472-475
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• 2006

Aspegillosis in free-living birds can be occurred mostly under poor weather and climate. But, captive birds tend to be more susceptible to infection and diagnosis was made usually at post mortem. A two months old Whooper swan(Cygnus c. cygmus) dying suddenly was found in a zoo without prior clinical signs. At necropsy, numerous well- demarcated yellow to white firm nodules were scattered throughout the air sacs and the lungs. Microscopically, granuloma formations were observed in the lung and air sacs. The margin of granuloma was surrounded by connective tissue barrier and was infiltrated with lymphocytes, and also observed giant cell near the granuloma. By Periodic acid Schiff reaction, hyphae were detected in granuloma of lung and air sacs. This case was diagnosed as an invasive pulmonary aspergillosis caused by Aspergillus fumigatus infection in a Whooper swan at a zoo.

• Molecules and Cells
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• v.43 no.9
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• pp.831-840
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• 2020

The β-class of carbonic anhydrases (β-CAs) are zinc metalloenzymes widely distributed in the fungal kingdom that play essential roles in growth, survival, differentiation, and virulence by catalyzing the reversible interconversion of carbon dioxide (CO₂) and bicarbonate (HCO₃^-). Herein, we report the biochemical and crystallographic characterization of the β-CA CafA from the fungal pathogen Aspergillus fumigatus, the main causative agent of invasive aspergillosis. CafA exhibited apparent in vitro CO₂ hydration activity in neutral to weak alkaline conditions, but little activity at acidic pH. The high-resolution crystal structure of CafA revealed a tetramer comprising a dimer of dimers, in which the catalytic zinc ion is tetrahedrally coordinated by three conserved residues (C119, H175, C178) and an acetate anion presumably acquired from the crystallization solution, indicating a freely accessible "open" conformation. Furthermore, knowledge of the structure of CafA in complex with the potent inhibitor acetazolamide, together with its functional intolerance of nitrate (NO₃^-) ions, could be exploited to develop new antifungal agents for the treatment of invasive aspergillosis.

• Tuberculosis and Respiratory Diseases
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• v.74 no.5
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• pp.231-234
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• 2013

Aspergillus causes a variety of clinical syndromes in the lung including tracheobronchial aspergillosis, invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, and aspergilloma. Aspergilloma usually results from ingrowths of colonized Aspergillus in damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. There are a few reports on endobronchial aspergilloma without underlying pulmonary lesion. We have experienced a case of endobronchial aspergilloma associated with foreign body developed in an immunocompetent patient without underlying lung diseases. A 59-year-old man is being hospitalized with recurring hemoptysis for 5 months. X-ray and computed tomography scans of chest showed a nodular opacity in superior segment of left lower lobe. Fiberoptic bronchoscopy revealed an irregular, mass-like, brownish material which totally obstructed the sub-segmental bronchus and a foreign body in superior segmental bronchus of the lower left lobe. Histopathologic examinations of biopsy specimen revealed fungal hyphae, characteristic of Aspergillus species.

• Journal of Korean Neurosurgical Society
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• v.53 no.5
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• pp.312-315
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• 2013

Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.1005-1010
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• 2021

We report a case of Immunoglobulin G4 (IgG4) related disease involving the pterygoplataine fossa. A 83-year-old male presented with left ocular pain and visual disturbance. CT showed an isodense soft tissue lesion in the left pterygopalatine fossa with bony sclerotic changes and erosion. MRI revealed an infiltrative soft tissue mass in the left pterygopalatine fossa as a T2 slightly low signal intensity and heterogeneous enhancement. The patient underwent left ethmoidectomy, and biopsy of the mass was conducted. The histopathological diagnosis was IgG4-related disease. In this case, it was difficult to differentiate invasive aspergillosis, which is common in immunocompromised patients, considering the patient's clinical history of diabetes mellitus. This report describes the imaging findings of IgG4-related disease mimicking invasive sinusitis such as invasive aspergillosis.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.60-64
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• 2006

Pulmonary aspergillosis presents as the following three different types depending on the immune status of the host: invasive aspergillosis, allergic bronchopulmonary aspergillosis (ABPA), and aspergilloma. Aspergilloma develops as a result of an aspergillus growth inside a pre-existing lung cavity. However, endobronchial aspergilloma without a lung parenchymal lesion is quite rare. We encountered a case of endobronchial aspergilloma that developed in a healthy 75 year-old woman that led to necrotizing pneumonia of the right lower lobe. The chief complaints were fever, cough and yellowish sputum. The chest film revealed haziness with cavity-like shadows on the right lower lobe, and the chest CT scan showed endobronchial calcified density in the basal bronchus of the right lower lobe with peribronchial lymph node enlargement. Bronchoscopy revealed an obstruction of the basal orifice of the right lower lobe by blackish stone-like material, and the aspergilloma was confirmed by the bronchoscopic biopsy. The pneumonia improved after bronchoscopic removal of this lesion. We report this case along with a review of the relevant literature.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.431-433
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• 2014

Aspergillus is a common saprophytic fungi of the human airways and causes a broad spectrum of diseases, ranging from aspergilloma to invasive aspergillosis. There are few reports on mediastinal aspergilloma without any underlying pulmonary disease or immunocompromise. Herein, we report a case of mediastinal aspergilloma that we experienced and treated by thoracoscopic resection and oral antifungal medication.

• Journal of Korean Neurosurgical Society
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• v.37 no.2
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• pp.146-149
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• 2005

Most primary spinal abscesses, irrespective of pathogens and anatomical locations, have better prognosis than that of secondary abscesses with spondylitis. We report a 68-year-old man, previously undertaken pulmonary resection due to tuberculosis, presented with paraparesis. Imaging studies showed primary intraspinal abscesses at T-1 and T-3 vertebral levels, semi-invasive pulmonary Aspergillosis and inflammation of the posterior mediastinum. Operative procedure and histopathological examination revealed interdural Aspergillus abscess. Despite chemotherapy, he deteriorated progressively, and spondylitis developed at corresponding vertebrae. He eventually died 6 weeks postoperatively due to pulmonary complication. The authors intended to inform that such an extradural inflammatory lesion of Aspergillus abscess should be treated carefully.