Fulminant orbital inflammation with intracranial spread mimicking angioinvasive fungal infection in an immunocompetent patient

Angioinvasive infections of the orbit are rapidly progressive and potentially fatal, most commonly occurring in immunocompromised individuals. However, similar clinical and radiological presentations may occasionally be encountered in immunocompetent patients, posing a diagnostic challenge. We present a case of a previously healthy male in his late 30s with progressive proptosis and loss of vision in the left eye. Clinical examination showed signs of orbital inflammation, exposure keratopathy, and complete ophthalmoplegia. Even in the absence of traditional risk factors, the radiological features were highly suggestive of invasive fungal infection. This case highlights the importance of early recognition of aggressive orbital infections, the limitations of microbiological diagnostics, and the need for prompt empirical therapy based on clinical and radiological suspicion.