Abu Dhabi: Patient’s eyes saved from a rare fungal infection

Abu Dhabi: Cleveland Clinic Abu Dhabi, part of the M42 group, successfully preserved the vision of a 57-year-old woman suffering from a rare and invasive fungal sinusitis, performing an intricate skull-base surgery that spared her from the need for orbital exenteration (eye removal).

The patient had previously undergone bilateral sinus surgery at another hospital, which led to post-operative maxillary sinusitis — a condition where the sinuses behind the cheeks became infected. She was later admitted to the Emergency Department of Cleveland Clinic Abu Dhabi with severe right-sided facial pain, swelling, nasal congestion, changes in her sense of smell, and debilitating headaches. Despite initial treatments with antibiotics and steroids, her condition worsened.

Complications

Further examination, including an MRI, revealed mucosal thickening and a breakthrough in the thin bone separating the sinuses from the orbital cavity. This caused the infection to dangerously approach her eye and raised concerns about it spreading further. A swab of the affected area confirmed an invasive fungal infection caused by Aspergillus, a type of fungus. Left untreated, the infection could have spread to nearby structures such as the brain, posing a significant risk to her life.

Intervention

A multidisciplinary team, led by Dr Mahdi Shkoukani, Chair of the Department of Otolaryngology Head & Neck Surgery at Cleveland Clinic Abu Dhabi, recognised the urgent need for intervention. They performed extensive surgical debridement to remove the infected tissue, including parts of the sinuses, the medial orbital wall, and the orbital fat around the eye.

Dr Shkoukani explained, “This was one of the rarest cases of sinusitis we have encountered in recent years. Although the patient had a functioning immune system, the fungal infection progressed to a stage where it threatened her eye and brain. This case highlights the critical importance of early diagnosis and prompt surgical and medical intervention for invasive fungal sinusitis.

Through surgery, we successfully removed all infected tissue while preserving her vision. We hope this case raises awareness about the severity of such infections and the importance of seeking immediate medical attention when symptoms persist or worsen.”

Healing

Following the surgery, the patient’s infection subsided, and her tissues began healing. A follow-up procedure two days later confirmed that there was no further fungal invasion, allowing her to avoid eye removal. She began antifungal treatment as soon as the infection was suspected and received close monitoring from the infectious disease team. Today, her sinuses have healed, and her vision remains intact.

What went wrong

Dr Shkoukani said: “Fungi like Aspergillus are naturally present in the sinuses and are typically harmless. However, under certain conditions, they can become aggressive, spreading to surrounding tissues, including the eyes and brain. In individuals with compromised immune systems, this progression can be rapid, leading to acute invasive fungal sinusitis. In healthy patients like this one, the progression is slower, resulting in chronic invasive sinusitis. Our advanced facilities and multidisciplinary expertise enable us to treat such complex cases with precision and care.”

Reflecting on her experience, the patient whose identity was not revealed, said: “I am incredibly grateful to the team at Cleveland Clinic Abu Dhabi for their quick action and expertise. It was a terrifying thought to lose my eye, but their skill and dedication saved me. I never imagined that a sinus infection could become so dangerous, and I hope my story encourages others to seek help early if they have persistent symptoms.”