A Case of Invasive Sino-Orbital Aspergillosis Presenting with Facial Nerve Palsy and Stroke

Purpose: To report a rare case of invasive sino-orbital aspergillosis initially presenting with orbital apex syndrome and subsequently progressing to facial nerve palsy and ischemic stroke.Case summary: A 58-year-old man presented with right-sided ptosis, upper eyelid swelling, and diplopia. Imaging and clinical findings were consistent with orbital apex syndrome. Intravenous antibiotic therapy was initiated; however, there was rapid deterioration in vision and ocular motility. After consultation with the otolaryngology department, high-dose intravenous corticosteroids were administered. Subsequently, the patient developed right-sided facial nerve palsy, central retinal artery occlusion, and right internal carotid artery occlusion, indicating disease progression. Histopathological examination later confirmed invasive aspergillosis. Corticosteroids were discontinued, and antifungal therapy combined with orbital exenteration led to clinical improvement.Conclusions: Invasive aspergillosis can rapidly extend to the orbit and intracranial structures, and corticosteroid administration without first excluding fungal infection may accelerate disease progression. The presence of facial nerve palsy and cerebrovascular complications suggests extensive angioinvasive spread, highlighting the importance of early diagnosis, prompt antifungal therapy, and surgical debridement. In patients with immunocompromising conditions, such as diabetes mellitus, fungal infection should always be strongly suspected and excluded at the outset to prevent severe complications.