Invasive bony destructive orbital aspergillosis in an immunocompetent child: a case report.

Purpose: To report a case of invasive sino-orbital aspergillosis, a rare condition in a healthy child. The patient presented with orbital involvement and bone destruction, an exceedingly uncommon occurrence that mimics other invasive inflammatory or neoplastic orbital lesions.

Case presentation: A 4-year-old female presented with an ill-defined, irregular, erythematous mass-like lesion measuring 8 × 10 mm on the left upper eyelid. Orbital computed tomography (CT) revealed an infiltrative soft tissue mass with bone erosions and destruction on the medial side of the frontal bone, extending toward the fronto-maxillary suture in the anterior orbit. Except for the left anterior ethmoidal sinus, the other paranasal sinuses were nearly clear. Magnetic resonance imaging (MRI) showed enhancement of the adjacent dura mater near the site of bony erosion and lesion expansion. The lesion was surgically excised, with drainage of mucopurulent discharge. Pathological examination revealed necrotizing granulomatous inflammation and fungal hyphae, with Aspergillus fumigatus growth confirmed by culture. The patient was diagnosed with invasive orbital aspergillosis. She was treated with intravenous and then oral voriconazole, and there was no recurrence of the disease.

Conclusions: Invasive orbital aspergillosis with bone destruction of the orbital walls can occur in immunocompetent individuals, including children, without any predisposing factors. It can mimic other invasive orbital diseases, leading to delayed diagnosis and treatment, which may result in life-threatening outcomes if intracranial spread occurs. Therefore, timely orbital biopsy of the lesions is crucial.