063 Actinomyces cavernous sinus infection: a case and systematic literature review. Issue 6 (24th May 2018)

• Record Type: Journal Article
• Authors: Lubomski, Michal; Dalgliesh, James; Lee, Kenneth; Damodaran, Omprakash; McKew, Genevieve; Reddel, Stephen
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 89:Issue 6(2018)
• Page Start: A26
• Page End: A26
• Publication Date: 2018-05-24
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-ANZAN.62
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Case: We report an unusual case of a 63 year old man who developed progressive right-sided exophthalmos, painful ophthalmoplegia, headaches and fevers with worsening depression over a two-month period, subsequently identified as an Actinomyces cavernous sinus (CS) infection. Preliminary diagnoses included giant cell arteritis then Tolosa-Hunt syndrome, with a transient response to steroids. Investigations showed a bland CSF and highly metabolically active brain FDG-PET suggesting lymphoma. Biopsy of the mass demonstrated gram-positive filamentous bacteria with Actinomyces -like colonies with sulphur granules. Actinomyces CS infections are rare. They often mimic non-infectious etiologies including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Conclusion: Clinicians should consider infective CS syndromes in fluctuating painful ophthalmoplegias with poor response to steroids. In our view, "Tolosa-Hunt" should not be used as a diagnosis but merely used as a descriptor for syndromes that resolve with corticosteroids in the absence of a more precise diagnosis.