THE BELGIAN OPHTHALMIC ASSOCIATIONS
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Cet abstract a été assigné à session AOB Posters 1
| Type de présentation | E-poster |
| Titre | Ophthalmoplegia and Vision Loss Due to Bilateral Cavernous Sinus Involvement in Extrapulmonary Tuberculosis |
| But | To present a case of extrapulmonary tuberculosis with bilateral cavernous sinus involvement |
| Méthodes | Case report |
| Résultats | A 41-year-old woman presented with headaches, right hemifacial hypoesthesia and binocular diplopia due to right sixth nerve palsy. This was followed by a right pupil involving third nerve palsy and later by a left sixth nerve palsy. Right inferior quadrantanopia was found on visual field testing. Initial cerebral MRI showed no abnormalities, but repeat MRI revealed a contrast enhancing lesion in the right cavernous sinus, vasculitis of the left internal carotid artery involving the intracavernous segment, and FLAIR hyperintensity in the left optic tract. Blood analysis showed elevated CRP and sedimentation rate as well as a positive QuantiFERON-TB Gold test. CSF analysis revealed subtle lymphocytic pleocytosis but negative cultures and PCR for M. tuberculosis. Chest X-ray and CT-scan were completely normal. 18-FDG PET-CT scan allowed to identify a hypermetabolic iliac lymph node: analysis after excision revealed multiple epithelioid cell granulomas with caseation necrosis. Subsequent PCR-testing returned positive and cultures grew drug-sensitive M. tuberculosis |
| Conclusion | Cavernous sinus involvement is a rare presentation of tuberculosis, and its diagnosis is often challenging. Pulmonary disease is often absent, CSF findings are often inconclusive and differentiating a solitary tuberculoma from other tumoral pathologies on imaging alone is difficult. If suspected, a careful search for an alternate site more accessible to biopsy should be undertaken in order to avoid invasive brain biopsy |
| Conflit d'intérêt | Non |
Auteurs 1
| Nom | HASSOUNEH |
| Initiales | B |
| Institut | CHU Saint-Pierre |
| Ville | Brussels |
Auteurs 2
| Nom | Kampouridis |
| Initiales | S |
| Institut | CHU Saint-Pierre |
| Ville | Brussels |
Auteurs 3
| Nom | Schulz |
| Initiales | J |
| Institut | CHU Saint-Pierre |
| Ville | Brussels |
Auteurs 4
| Nom | Genderini |
| Initiales | F |
| Institut | CHU Saint-Pierre |
| Ville | Brussels |
Auteurs 5
| Nom | Willermain |
| Initiales | F |
| Institut | CHU Saint-Pierre |
| Ville | Brussels |
Auteurs 6
| Nom | Buelens |
| Initiales | T |
| Institut | CHU Saint-Pierre |
| Ville | Brussels |