[A case of hypertrophic pachymeningitis impeding differential diagnosis of mycosis of orbital apex syndrome].
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.
Suzuki
Kaori
K
Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan. kaorisuz@cc.hirosaki-u.ac.jp
Suzuki
Yukihiko
Y
Yokoi
Yumiko
Y
Miyagawa
Yasuhiro
Y
Metoki
Tomomi
T
Yamazaki
Hitoshi
H
Nakazawa
Mitsuru
M
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