title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. shazlyt@gmail.com.|, 203 Lothrop St, Pittsburgh, PA, 15213, USA. shazlyt@gmail.com.
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Shazly
authors.affiliation: UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. mitchelleb@upmc.edu.
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Mitchell
authors.affiliation: UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Bonhommegr@upmc.edu.
authors.forename: Gabrielle R
authors.initials: GR
authors.lastname: Bonhomme
authors.affiliation: UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. SchumanJs@upmc.edu.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Schuman
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D059248:Chemoradiotherapy; D003937:Diagnosis, Differential; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009918:Orbital Neoplasms / Q000175:diagnosis* / Q000628:therapy; D049268:Positron-Emission Tomography; D020333:Tolosa-Hunt Syndrome / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed