Lymphoma of the orbit masquerading as Tolosa-Hunt syndrome.

Abstract

BACKGROUND:

Tolosa-Hunt syndrome is a rare clinical syndrome characterized by painful ophthalmoplegia and ipsilateral cranial neuropathies. It is caused by an inflammatory process of unknown etiology.

CASE PRESENTATION:

We present a case of a 77-year-old white man with history of Waldenstrom's macroglobulinemia transforming to large B-cell lymphoma who presented to a community physician complaining of 4 months of isolated right retro-orbital pain and later with diplopia, ptosis, 6th nerve and pupil-sparing partial 3rd nerve palsies as well as progressive neurological findings. His clinical course was complicated by debilitating neurological symptoms and multiple hospitalizations leading to a delay in diagnosis caused by incomplete initial workup.

CONCLUSION:

This case is a reminder that lymphoproliferative disorders often mimic other neurologic disorders and that Tolosa-Hunt is a rare diagnosis that must be considered a diagnosis of exclusion.

• Authors: Tarek A Shazly, Ellen B Mitchell, Gabrielle R Bonhomme, Joel S Schuman
• Journal: BMC ophthalmology (BMC Ophthalmol) Vol. 15 Pg. 51 (May 15 2015) ISSN: 1471-2415 [Electronic] England
• PMID: 25971316 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Biopsy, Fine-Needle
• Chemoradiotherapy
• Diagnosis, Differential
• Humans
• Lymphoma, Large B-Cell, Diffuse (diagnosis, therapy)
• Magnetic Resonance Imaging
• Male
• Orbital Neoplasms (diagnosis, therapy)
• Positron-Emission Tomography
• Tolosa-Hunt Syndrome (diagnosis)
• Tomography, X-Ray Computed