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Oculoplastics

Orbital fungal infections often misdiagnosed

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Although orbital fungal infections are rare in the United States, they are often misdiagnosed, leading to delays in treatment, according to a presentation at ASOPRS 2020 Fall Scientific Symposium by Brittany A. Simmons, MD.

Mortality for orbital fungal infections range from 18%-85%, or <55% after amphotericin B, said Dr Simmons.

In a retrospective chart review to evaluate outcomes of orbital mycoses, 49 confirmed fungal infections of the orbit were identified.

“One thing we learned is we have a high rate of misdiagnosis when it comes to this disease entity,” said Dr Simmons.

More than two-thirds (67%) of cases were misdiagnosed as a non-fungal diagnosis. The most common misdiagnoses were bacterial cellulitis (24.5%), sinusitis (24.5%), and inflammatory (18.4%), including giant cell arteritis (10.2%) Idiopathic orbital inflammation (6.1%), and optic neuritis (2.0%).

Dr Simmons noted that “78% of cases initially misdiagnoses as being inflammatory in nature were treated with steroids at presentation.”

She concluded her presentation by asking if ophthalmologists are “so used to seeing what’s common that we lean towards those diagnoses?”

Orbital fungal infections, she said, require a high index of suspicion.

Reference

Simmons BA, et al. Misdiagnosis of Fungal Infections of the Orbit in the United States. Presented at: ASOPRS 2020 Fall Scientific Symposium.

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