Aspergillus growth within exenterated cavity resembling a “valley of flowers”

Lid-sparing exenteration with adjuvant radiotherapy was performed for a middle-aged female for orbital recurrence of choroidal melanoma. Postoperatively, she developed sino-orbital fistula. Examination of the exenterated orbital cavity showed a colony of Aspergillus species growth resembling a bloom of chrysanthemum [Fig. 1a]. Medusa-like conidiophores, which are pathognomic of Aspergillus infection were seen, which were initially white to yellow and then turning black [Fig. 1b]. Unlike mucormycosis, Aspergillus can affect an immunocompetent patient and has been rarely reported in the exenterated cavity. The characteristic globular head (fruiting bodies), conidiophores, usually are found in culture media and rarely in tissues when the organism grows inside aerated cavities like the lung, sinus cavities, and exenterated cavity as in this patient.[1,2] Patient was managed by surgical debridement of the involved soft tissue along with systemic antifungal therapy.Figure 1: A colony of Aspergillus species growth inside an exenterated orbital cavity (a). Closeup view showing the medusa head-like conidiophores (fruiting bodies) of Aspergillus with cottony appearance and white to yellow color that turns black with progression of infection (b)Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.