Woman With Ptosis.

Abstract

An 87-year-old woman, with a medical history of type 2 diabetes mellitus, hypertension, and dementia, reported right ptosis and ophthalmoplegia for 6 days. On arrival at the emergency department (ED), the patient was alert and oriented without acute distress. Her body temperature was 35.7°C, her heart rate was 82 beats/min, her respiratory rate was 16 breaths/min, and her blood pressure was 147/66 mm Hg. Tracing back her history, the patient had chronic nasal congestion for 1 year. There was no fever and no headache. Neurological examination showed paralysis of the right oculomotor nerve, presenting with right eye ptosis, mydriasis, and outer-down position. The blood laboratory results were unremarkable. Cranial computed tomography (CT) revealed a heterogeneous mass with calcifi cations in the right maxillary and left sphenoid sinuses with bony erosion (Fig. 1). Subsequently, contrast-enhanced magnetic resonance imaging (MRI) was performed, which showed a hypointense lesion with peripheral enhancement over the left sphenoid, right maxillary, right ethmoid sinuses, and compression of the right inferior rectus muscle (Fig. 2). After surgical debridement was performed, the pathology report of the specimen revealed aspergillosis. Antibiotics were discontinued and anti-fungal agents were started. Afrer 1 month after the initial treatment passed, she was able to the right eye halfway.