Dr.ASHA SAMDANI

Dr. MANDEEP SINGH BAJAJ, Dr.SUJEETH MODABOYINA, Dr.NAVNEET SIDHU

Abstract

A 55 yo diabetic male presented with dull retrobulbar pain, stuffy nose and unilateral inferior lid fullness. He was a known case of ABPA on oral voriconazole for 2 years with no significant improvement. Previous imaging and biopsy revealed sino-orbital disease and Aspergillus respectively.

In view of recalcitrance to treatment, repeat biopsy was done. Greyish avascular mass was noted with isolates of Aspergillus flavus. Sensitivity was ordered and found that the fungal culture isolate was multi drug resistant to all the routine antifungals including voriconazole but sensitive to Posaconazole. Oral Posaconazole 200 mg (5 ml) TDS was started and imaging was repeated after six weeks. Reduction in extent of lesion on CECT was noted with resolution of inferior orbital fullness. This case emphasizes the importance of performing sensitivity as a routine in all cases of sino-orbital infections along with tissue diagnosis especially in cases non responding to conventional treatment.