Lubomski, M., Dalgliesh, J., Lee, K., Damodaran, O., McKew, G., & Reddel, S. (2018). Actinomyces cavernous sinus infection: A case and systematic literature review. Pratical Neurology, Early View (Online First).
A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis then Tolosa-Hunt syndrome and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain (18F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with Actinomyces-like colonies. Actinomyces cavernous sinus infections are rare and indolent. They often mimic non-infective causes including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Clinicians should consider infective cavernous sinus syndromes in people with a fluctuating painful ophthalmoplegia that responds poorly to corticosteroids. The term Tolosa-Hunt syndrome is problematic and should be retired or used only with reservation.
exophthalmos, painful ophthalmoplegia, infective cavernous sinus syndromes, Tolosa-Hunt syndrome, Actinomyces, literature review