Assuntos
Autoanticorpos/sangue , Glicoproteína Mielina-Oligodendrócito/imunologia , Neurite Óptica/diagnóstico , Síndrome de Sjogren/diagnóstico , Adulto , Aquaporina 4/imunologia , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/sangue , Infusões Intravenosas , Imageamento por Ressonância Magnética , Metilprednisolona/uso terapêutico , Neurite Óptica/tratamento farmacológico , Neurite Óptica/imunologia , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/imunologia , Acuidade Visual/fisiologia , Campos Visuais/fisiologiaRESUMO
PURPOSE: To describe a rare case of Burkitt lymphoma metastatic to the cavernous sinus that was initially diagnosed as Tolosa-Hunt syndrome. CASE DESCRIPTION: A 31-year-old confirmed and treatment-compliant HIV-positive Hispanic male acutely developed diplopia, ptosis, numbness in the V1 distribution, and complete external ophthalmoplegia in the right eye over 1 week. Imaging showed a mass-like lesion within the right cavernous sinus without other intracranial abnormalities. He was started on broad-spectrum antibiotics and antifungals without improvement. Inflammatory and infectious workup was negative. A presumed diagnosis of Tolosa-Hunt syndrome was made based on clinical and radiographic findings, as well as the absence of another etiology to explain the patient's presentation. He was then started on high-dose oral steroids with improvement of orbital pain only. Shortly after being discharged on steroids, the patient returned to the hospital with severe abdominal pain. Computed tomography of the abdomen showed perforated ileitis with aneurysmal dilation of the ileum and marked wall thickening concerning for a mass lesion. Positron emission tomography-computed tomography showed an uptake in the terminal ileum and right cavernous sinus consistent with metastatic Burkitt lymphoma, matching with pathology. After several cycles of chemotherapy, symptoms improved, and he regained full ocular motility in the affected eye. However, the patient ultimately died due to peritonitis and pyelonephritis. CONCLUSION: Burkitt lymphoma metastatic to the cavernous sinus was diagnosed after an initial diagnosis of Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a diagnosis of exclusion and should only be made after ruling out other pathologies.
Assuntos
Linfoma de Burkitt/diagnóstico , Seio Cavernoso , Infecções por HIV/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico , Síndrome de Tolosa-Hunt/diagnóstico , Neoplasias Vasculares/diagnóstico , Adulto , Diagnóstico Diferencial , Evolução Fatal , Humanos , MasculinoRESUMO
Giant cell arteritis (GCA) is an inflammatory vasculitis typically affecting elderly that can potentially cause vision loss. Studies have demonstrated that early recognition and initiation of treatment can improve visual prognosis in patients with GCA. This review addresses the benefits of early diagnosis and treatment, and discusses the available treatment options to manage the disease.
