Sino-orbital aspergillosis treated with combination antifungal therapy. Successful therapy after failure with amphotericin B and surgery.

ASPERGILLOSIS of the paranasal sinus and orbit is well recognized. 1 Local invasion of the sinus or orbit by Aspergillus has been managed successfully with surgery, whereas amphotericin B as sole therapy is considered inadequate. 1 However, when sinus invasion is complicated by decreasing visual acuity and neurological signs, the course has invariably been fatal, even when aggressive surgery was combined with amphotericin B therapy. (A reference list will be provided with reprint requests.) We present a case of sinus aspergillosis that showed malignant progression despite surgery, treatment with amphotericin B, and the results of in vitro susceptibility testing for the fungus involved. When combination antifungal therapy (viz, addition of flucytosine and rifampin to the amphotericin B regimen) was instituted, a dramatic clinical response was noted, with gradual resolution of symptoms and neurological abnormalities. Materials and Methods Susceptibility testing was performed by the broth dilution method, using yeast nitrogen base