ORBITAL ASPERGILLOSIS - A FATAL MASQUERADER

Ocular manifestations of aspergillosis are emerging as increasingly mo re atypical, with a wide spectrum of presentations. The classic teachi ng is that this fungus presents as an endogenous endophthalmitis in im munocompromised hosts. In most other ocular conditions, the index of s uspicion for this infection has typically been low, especially in appa rently immunocompetent individuals. However, reports continue to appea r that confirm involvement of Aspergillus species in a wide variety of primary ocular and orbital conditions characterized by rapid, uncontr ollable progression and, not uncommonly, death. This report highlights a case of autopsy-proven orbital aspergillosis that masqueraded as te mporal arteritis in terms of initial clinical presentation and respons e to standard therapy. Any ocular condition that manifests even subtle atypical features, including temporal arteritis, should be regarded a s suspect, and an aggressive approach to secure a biopsy of any involv ed sites should follow.