Elsevier

Auris Nasus Larynx

Volume 36, Issue 2, April 2009, Pages 224-227
Auris Nasus Larynx

Clinical significance of (1→3)-β-d-glucan in a patient with invasive sino-orbital aspergillosis

https://doi.org/10.1016/j.anl.2008.05.015Get rights and content

Abstract

Objectives

The usefulness of BG as a marker has been reported in patients with pulmonary aspergillosis. However, no data have demonstrated the behavior of BG in sino-orbital IA. We encountered a case of sino-orbital IA and demonstrated changes in the BG level, radiological images, and pathological features.

Method and results

A 63-year-old Japanese woman suffered from invasive sino-orbital aspergillosis. The serum BG level measured immediately before surgery was 37.2 pg/mL (normal value <3.4 pg/mL). Endoscopic sinus surgery revealed some necrotic tissue extending from the ethmoid sinus to the orbit. The infiltrating Aspergillus was revealed in the pathological examination. The BG level decreased to the normal value. However, CT revealed a high-density area; this may indicate that an aspergillosis lesion remained slightly in the orbit.

Conclusion

(1→3)-β-d-Glucan (BG) is a useful marker for diagnosing Aspergillus and evaluating the therapeutic effect of the treatment administered.

Introduction

With the increase in the number of compromised hosts, the instances of human immunodeficiency virus (HIV) infection, malignant tumors, abuse of antibiotics, and the invasive aspergillosis (IA) of the paranasal sinuses have been observed sometimes [1], [2]. A series of radiological, microbiological, serological, and pathological examinations have been applied for the diagnosis of IA. However, their clinical use is limited, and the early and acute diagnosis of IA is still difficult in some cases. Recently, a novel method to detect (1→3)-β-d-glucan (BG), one of the major and common cell wall constituents of fungi, has been developed [3], [4]. An assay for BG may be a promising means for diagnosing fungal diseases. The usefulness of BG as a marker has been reported in patients with pulmonary aspergillosis [5], [6], [7]. However, no data have demonstrated the behavior of BG in sino-orbital IA. In this case, we demonstrate changes in the BG level, radiological images, and pathological features.

Section snippets

Case report

A 63-year-old Japanese woman suffered from headache and diplopia. She had suffered from breast cancer and had been administered surgical therapy alone. From September 2004, she complained of headache and rhinorrhea; she was diagnosed with chronic sinusitis and treated with antibiotics (macrolide, etc.). However, her symptoms did not improve. In February 2005, a computed tomography (CT) scan showed bone destruction in an area of soft tissue density extending from the right ethmoid sinus to the

Discussion

Aspergillosis in the paranasal sinus can be either invasive or noninvasive [8]. The vast majority of aspergillosis cases are of the noninvasive type and have a good prognosis. The invasive type of aspergillosis results in bone destruction and intraorbital and intracranial extensions similar to those observed in a malignant neoplasm [9]. In the invasive type of aspergillosis in the paranasal sinus (sino-orbital aspergillosis), an accurate diagnosis and treatment is difficult, thus resulting in a

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