Nasolacrimal Fungal Granuloma
A 40-year-old man with a past medical history significant only for hyperthyroidism, and no past ocular history, presented with “several months” of left sided proptosis associated with bloody tears, left eye pain, and unilateral blurry vision. He denied trauma, fevers, chills, and other systemic symptoms. Initial exam was notable for decreased visual acuity to 20/60 on the left and 4mm of left sided proptosis. CT orbit demonstrated a heterogeneous, unencapsulated mass in the left medial orbit at the location of the proximal nasolacrimal duct, extending into the nasal cavity. Incisional biopsy was performed. Histopathological analysis demonstrated fibrovascular tissue with foci of granulomatous inflammation and fungal hyphae. The patient was started on oral fluconazole with plans for a minimum course of 2 months and awaits further follow up and work-up.
Chronic fungal infections of the orbit are extremely rare in immunocompetent patients and can masquerade as inflammatory or malignant conditions. They occur primarily in subtropical and tropical environments, and can present non-specifically with proptosis, eyelid full, pain, extraocular movement restriction, blurry vision, or a palpable mass. Orbital imaging, histopathological analysis, and tissue culture are essential for diagnosis. Treatment options include surgical excision or debridement as well as systemic antifungal therapy.
Presentation Date: 12/03/2020
Issue Date: 06/25/2021
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