A CASE OF FUNGAL SINUSITIS PRESENTING AS ORBITAL CELLULITIS IN AN IMMUNOCOMPETENT MALE

Abstract

ABSTRACT - Fungal sinusitis presenting as orbital cellulitis is rare in immunocompetent persons. A 15 yrs old male presented to our OPD with complaints of upper lid  swelling in the RE for the past 1 week associated with pain. He also had pain on extraocular movements, fever for the past 2 weeks, which is of high grade. No specific complaints related to sinusitis. Patient was treated at nearby GH with systemic antibiotics ,but there was no improvement so he was referred to a higher institution. OE patient was febrile and oriented. Ocular examination showed VISION of 612, not improving with pinhole. He had swelling and erythema around the eyebrows with fullness present over the right forehead which was tender. Periorbital edema with mechanical ptosis was present. Painful restriction of elevation was present with chemosis present over the temporal aspect of the conjunctiva. Fundus was normal along with normal colour vision and fields. Diagnosis of orbital cellulitis with sinusitis of the frontal and ethmoid was made, based on the ophthalmological and ENT findings and correlated with the imaging studies.  Immediate surgical debridement was done which showed fungal debris following which systemic antifungals were started, which limited the spread of infection. The purpose of this presentation is to emphasise that not all orbital  complications secondary to sinusitis are bacterial.                   Presentation of fungus-related orbital complications in           immunocompetent individuals can occur rarely, as in our case.