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This abstract is assigned to session AOB Posters 1

Presentation type	E-poster
Title	Ophthalmoplegia and Vision Loss Due to Bilateral Cavernous Sinus Involvement in Extrapulmonary Tuberculosis

Purpose	To present a case of extrapulmonary tuberculosis with bilateral cavernous sinus involvement
Methods	Case report
Results	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
Conflict of interest	No

Authors 1

Last name	HASSOUNEH
Initials	B
Department	CHU Saint-Pierre
City	Brussels

Authors 2

Last name	Kampouridis
Initials	S
Department	CHU Saint-Pierre
City	Brussels

Authors 3

Last name	Schulz
Initials	J
Department	CHU Saint-Pierre
City	Brussels

Authors 4

Last name	Genderini
Initials	F
Department	CHU Saint-Pierre
City	Brussels

Authors 5

Last name	Willermain
Initials	F
Department	CHU Saint-Pierre
City	Brussels

Authors 6

Last name	Buelens
Initials	T
Department	CHU Saint-Pierre
City	Brussels