TY - JOUR T1 - <em>Actinomyces</em> cavernous sinus infection: a case and systematic literature review JF - Practical Neurology JO - Pract Neurol DO - 10.1136/practneurol-2017-001844 SP - practneurol-2017-001844 AU - Michal Lubomski AU - James Dalgliesh AU - Kenneth Lee AU - Omprakash Damodaran AU - Genevieve McKew AU - Stephen Reddel Y1 - 2018/04/12 UR - http://pn.bmj.com/content/early/2018/04/12/practneurol-2017-001844.abstract N2 - 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. ER -