Optic neuropathy caused by naso-orbital mass in chronic intranasal cocaine abuse.
A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.
Shen
Christopher C
CC
Hamilton Eye Institute, University of Tennessee, Health Sciences Center, Memphis, Tennessee 38163, USA.
Silver
Amanda L
AL
O'Donnell
Thomas J
TJ
Fleming
James C
JC
Karcioglu
Zeynel A
ZA
D000281:Administration, Intranasal; D001766:Blindness / Q000175:diagnosis / Q000209:etiology; D002481:Cellulitis / Q000175:diagnosis / Q000209:etiology; D002908:Chronic Disease; D003042:Cocaine / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000150:complications*; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology*; D009915:Orbit / Q000473:pathology; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed
D003042:Cocaine