Infraorbital aspergillosis masquerading as a Skin Adnexal Tumor: A Diagnostic Dilemma: A Rare Case Report

Infraorbital aspergillosis is a rare presentation of fungal infection that may clinically simulate a neoplastic lesion, posing significant diagnostic challenges. We report a case of a 65-year-old woman who presented with gradually progressive swelling and pain in the left infraorbital region for six months. She had a past history of treated pulmonary tuberculosis. Radiological evaluation revealed a heterogeneously enhancing soft tissue mass without sinonasal involvement, raising suspicion of a skin adnexal tumor. Surgical excision was performed. Histopathological examination showed granulomatous inflammation with multinucleated giant cells, necrosis, and granulation tissue. Special stains, including Periodic Acid-Schiff and Grocott-Gomori Methenamine Silver, demonstrated septate fungal hyphae with acute angle branching, confirming aspergillosis. No evidence of malignancy was identified. The patient responded well to combine surgical and antifungal therapy. This case emphasizes the importance of considering fungal infections in the differential diagnosis of infraorbital mass lesions to ensure timely diagnosis and prevent serious complications.