Lips to die for: invasive sino-orbital aspergillosis after dermal filler injections presenting with cavernous sinus thrombosis, ICA stenosis, and pseudoaneurysm

Discover a critical clinical case presented by Nikola Serman (Zagreb, Croatia) involving a 43-year-old female patient who developed life-threatening complications following cosmetic hyaluronic acid dermal filler injections.

Initially misdiagnosed as a bacterial infection, the patient presented with frontal headache, periorbital pain, proptosis, and early optic neuropathy. Advanced imaging (MRI, DSA) revealed invasive sino-orbital aspergillosis causing severe vascular complications, including cavernous sinus thrombosis, internal carotid artery (ICA) stenosis, and a 3.5 mm pseudoaneurysm.

To manage this complex pseudoaneurysm, the team executed a sophisticated endovascular reconstruction strategy, involving protective coil embolization followed by a telescopic construct of five flow diverters to successfully preserve the ICA. After shifting from antibiotics to targeted systemic antifungal therapy, the inflammatory changes completely resolved.

Watch the full case presentation to analyze the patient journey, review the complete treatment strategy, and understand why this multi-layer flow diverter approach was chosen to manage this vascular-invasive aspergillosis.