PT  - JOURNAL ARTICLE
AU  - Michal Lubomski
AU  - James Dalgliesh
AU  - Kenneth Lee
AU  - Omprakash Damodaran
AU  - Genevieve McKew
AU  - Stephen Reddel
TI  - <em>Actinomyces</em> cavernous sinus infection: a case and systematic literature review
AID  - 10.1136/practneurol-2017-001844
DP  - 2018 Apr 12
TA  - Practical Neurology
PG  - practneurol-2017-001844
4099  - http://pn.bmj.com/content/early/2018/04/12/practneurol-2017-001844.short
4100  - http://pn.bmj.com/content/early/2018/04/12/practneurol-2017-001844.full
AB  - 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.