Orbital aspergillosis. A fatal masquerader.

Ocular manifestations of aspergillosis are emerging as increasingly more atypical, with a wide spectrum of presentations. The classic teaching is that this fungus presents as an endogenous endophthalmitis in immunocompromised hosts. In most other ocular conditions, the index of suspicion for this infection has typically been low, especially in apparently immunocompetent individuals. However, reports continue to appear that confirm involvement of Aspergillus species in a wide variety of primary ocular and orbital conditions characterized by rapid, uncontrollable progression and, not uncommonly, death. This report highlights a case of autopsy-proven orbital aspergillosis that masqueraded as temporal arteritis in terms of initial clinical presentation and response to standard therapy. Any ocular condition that manifests even subtle atypical features, including temporal arteritis, should be regarded as suspect, and an aggressive approach to secure a biopsy of any involved sites should follow.