Rhino-orbital fungal infection mimicking orbital malignancy – is traditional herbal preparation a predisposing factor?: Report of two cases
Keywords:Rhino-orbito-cerebral, Fungal infection, Recurrence, Traditional herbal preparation, Ghana
Background: Chronic inflammatory reactions may present clinically as a neoplastic lesion. In both
immunocompromised and immunocompetent patients with orbital pathology, fungal infection should be
considered when the presenting features are unusual or patient is not responding to standard therapy. The
prognosis for sight and even life may be dire if not managed properly.
Case presentations: We report two cases of fungal infections with clinical characteristics similar to orbital
malignancy. Both patients reported the use of plant based herbal medication as eye, ear and/or nose drops for
minor ailments. The first case was a 32-year old female who presented with a two-year history of superior-medial
painless orbital swelling associated with proptosis. The second case was a 36-year old man who presented
with a one-year history of painless inferior-medial orbital mass. Head and orbit CT scans with contrast showed
features consistent with an orbital malignancy in both patients. Incisional biopsy reported fungal infection and
fungal staining revealed hyphae in both patients. Determining the specific fungal agent was a challenge as
the specimens were solid masses and paraffin-embedded blocks were prepared, unlike a wet mount in which
septated or non-septated hyphae could aid in this differentiation. Immunohistochemistry was not done due to
Conclusion: Rhino-orbito-cerebral fungal infection can present with features masquerading an orbital
malignancy or orbital inflammatory disease. Traditional herbal preparations for common ailments of the eye,
ear and nose may be a predisposing factor. Debulking surgery and oral antifungals may be considered in the
management of rhino-orbital fungal infection in a resource poor setting.
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