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Invasive sphenoid sinus aspergillosis with normal findings on initial diagnostic tests that mimics Tolosa-Hunt syndrome—a diagnostic dilemma: a case report

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Author(s)
Yu Hun JeongJongsuk ChoiByung-Jo KimHung Youl Seok
Keimyung Author(s)
Seok, Hung Youl
Department
Dept. of Neurology (신경과학)
Journal Title
J Yeungnam Med Sci
Issued Date
2023
Volume
40
Issue
2
Keyword
AspergillosisPainful ophthalmoplegiaSphenoid sinusTolosa-Hunt syndrome
Abstract
Invasive sphenoid sinus aspergillosis can mimic Tolosa-Hunt syndrome (THS), leading to frequent misdiagnoses and potentially fatal consequences. We report a case of invasive sphenoid sinus aspergillosis initially misdiagnosed as THS. A 79-year-old man presented with right periorbital pain, ophthalmoplegia, and loss of vision. Initial evaluations including magnetic resonance imaging (MRI), were normal. He was first diagnosed with THS based on clinical features. The disease progressed despite high-dose intravenous steroid treatment, and an enhancing mass-like lesion was found in the right orbital apex, cavernous sinus, and sphenoid sinus on follow-up MRI. Aspergillosis was eventually confirmed by sphenoid sinus biopsy. The patient developed cerebral infarction and finally died despite being treated with amphotericin B. Given that invasive sphenoid sinus aspergillosis may initially resemble THS, high suspicion and rapid histological examination are important for diagnosis.
Keimyung Author(s)(Kor)
석흥열
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2799-8010
Source
https://www.e-jyms.org/journal/view.php?doi=10.12701/jyms.2021.01494
DOI
10.12701/jyms.2021.01494
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44899
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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