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