title: [A case of hypertrophic pachymeningitis impeding differential diagnosis of mycosis of orbital apex syndrome].
abstract: OBJECTIVE
  Mycosis of the orbital apex is often fatal. We report case of orbital apex syndrome, which appeared to have been caused by hypertrophic pachymeningitis with positive systemic mycosis antigens treated with systemic corticosteroid combined with antimicrobiotic therapy.
  
  
  METHODS
  A 57-year-old woman presented with disturbed ocular motility and visual disturbance of her left eye. She had rheumatoid arthritis. Magnetic resonance imaging(MRI) showed an abnormal blush in the left orbital apex and meningeal thickening in the cranial base, leading to the diagnosis of hypertrophic pachymeningitis. She also had candidemia. Systemic corticosteroids combined with antimicrobiotic therapy resulted in improved clinical ocular manifestations. She died 13 months later due to interstitial pneumonia.
  
  
  CONCLUSIONS
  The diagnosis of this case was difficult because of the candidemia. But the effective steroid response indicates that the probable cause was hypertrophic pachymeningitis due to RA. To avoid complications, hypertrophic pachymeningitis associated with fungemia should be treated with corticosteroids combined with antimicrobiotic therapy.
authors.affiliation: Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan. kaorisuz@cc.hirosaki-u.ac.jp
authors.forename: Kaori
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Yokoi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyagawa
authors.forename: Tomomi
authors.initials: T
authors.lastname: Metoki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamazaki
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Nakazawa
mesh_terms: D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D016921:Meningitis, Fungal / Q000150:complications*; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis* / Q000209:etiology