RT Journal Article SR Electronic T1 Actinomyces cavernous sinus infection: a case and systematic literature review JF Practical Neurology JO Pract Neurol FD BMJ Publishing Group Ltd SP practneurol-2017-001844 DO 10.1136/practneurol-2017-001844 A1 Michal Lubomski A1 James Dalgliesh A1 Kenneth Lee A1 Omprakash Damodaran A1 Genevieve McKew A1 Stephen Reddel YR 2018 UL http://pn.bmj.com/content/early/2018/04/12/practneurol-2017-001844.abstract 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.