{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:02:04Z","timestamp":1785124924140,"version":"3.55.0"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    We report a diagnostically challenging case of polymicrobial orbital apex syndrome in an immunocompromised patient, emphasizing the importance of early multidisciplinary intervention and consideration of fungal aetiologies in high-risk individuals. A 70-year-old woman with multiple comorbidities presented with subacute left orbital pain and frontotemporal headache, with early signs of cranial nerve VI palsy. Despite initial stability, the patient deteriorated over 2\u2009weeks, developing complete left ophthalmoplegia, proptosis, and vision loss. Further investigation demonstrated a polymicrobial skull base osteomyelitis with orbital apex and cavernous sinus involvement. Histopathology revealed necrotic material with chronic inflammation, and cultures identified\n                    <jats:italic toggle=\"yes\">Aspergillus flavus<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                    , and\n                    <jats:italic toggle=\"yes\">Candida parapsilosis<\/jats:italic>\n                    . The patient was treated with intravenous vancomycin, oral ciprofloxacin, and voriconazole for 6\u20138\u2009weeks. Diagnosing orbital apex syndrome in immunocompromised individuals is complex and early imaging is critical. A high clinical suspicion for fungal infection should be maintained, with a strong role for timely tissue diagnosis. Coordinated multidisciplinary care and targeted antimicrobial therapy can prevent further morbidity from intracranial extension.\n                  <\/jats:p>","DOI":"10.1177\/2050313x261465145","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:18:48Z","timestamp":1784956728000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Polymicrobial orbital apex syndrome in an immunocompromised patient: A multidisciplinary diagnostic challenge"],"prefix":"10.1177","volume":"14","author":[{"given":"Elizabeth Y. X.","family":"Leong","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, National University Health System, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2834-1192","authenticated-orcid":false,"given":"Alex J. Y.","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National University Health System, Singapore, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbin","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National University Health System, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryanne Romero","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National University Health System, Singapore, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terese Huiying","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Ng Teng Fong General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanche X. H.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National University Health System, Singapore, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Badakere A Patil-Chhablani P. Orbital apex syndrome: a review. Eye Brain 2019; 11: 63\u201372. https:\/\/doi.org\/10.2147\/eb.S180190","DOI":"10.2147\/EB.S180190"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Aryasit O Preechawai P Aui-Aree N. Clinical presentation aetiology and prognosis of orbital apex syndrome. Orbit 2013; 32: 91\u201394. https:\/\/doi.org\/10.3109\/01676830.2013.764439","DOI":"10.3109\/01676830.2013.764439"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Lee PH Shao SC Lee WA. 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