title: Extrapulmonary tuberculosis presenting as a cavernous sinus syndrome: Case report with review of existing literature.
abstract: Tuberculoma involving the cavernous sinus is a rare presentation of CNS disease, with only twelve cases reported in previous literature. We report a case of a 48 year old woman who presented with a right cavernous sinus syndrome of 2 months duration. MRI showed a mass in the right cavernous sinus, and serologic workup revealed an elevated sedimentation rate and positive Quantiferon(®)-GOLD testing. 18-FDG PET-CT demonstrated a hypermetabolic 3 cm subcarinal lymph node, and lymph node biopsy showed caseating granuloma. Culture of lymphatic tissue grew drug-sensitive M. tuberculosis. The patient was treated with a non-standard 4-drug regimen and prednisone, with rapid improvement of symptoms and radiologic abnormalities. Total length of treatment was 12 months. In addition, we review the 12 cases found in literature, and discuss clinical features, diagnostic dilemmas, and approaches to treatment.
authors.affiliation: Rutgers New Jersey Medical School, Newark, NJ, United States.
authors.forename: Shashi
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: Rutgers New Jersey Medical School, Newark, NJ, United States.
authors.forename: Amee
authors.initials: A
authors.lastname: Patrawalla
keywords: CNS tuberculosis; Cavernous sinus syndrome; Extrapulmonary tuberculosis; FDG-PET; Tuberculoma; Tuberculosis
references.citation: Surg Neurol Int. 2013 Dec 17;4:158
references.pmid: 24381801
references.citation: Eur Neurol. 2002;47(2):125-6
references.pmid: 11844904
references.citation: J Assoc Physicians India. 1993 Sep;41(9):559-61
references.pmid: 8307908
references.citation: MMWR Recomm Rep. 2003 Jun 20;52(RR-11):1-77
references.pmid: 12836625
references.citation: Clin Infect Dis. 1992 Jul;15(1):181-2
references.pmid: 1617066
references.citation: Singapore Med J. 2005 Dec;46(12):731-3
references.pmid: 16308650
references.citation: Neurosurgery. 1998 Jan;42(1):179-81; discussion 181-2
references.pmid: 9442521
references.citation: Scand J Infect Dis. 2001;33(11):868-70
references.pmid: 11760175
references.citation: Clin Infect Dis. 2009 Nov 1;49(9):1350-7
references.pmid: 19793000
references.citation: J Neuroophthalmol. 1997 Sep;17(3):207-8
references.pmid: 9304538
references.citation: Neurol India. 1999 Sep;47(3):238-40
references.pmid: 10514587
references.citation: Br J Neurosurg. 1990;4(5):391-6
references.pmid: 2261101
references.citation: J Neuroimaging. 2007 Jul;17(3):264-8
references.pmid: 17608916
references.citation: Tuberculosis (Edinb). 2010 Sep;90(5):279-92
references.pmid: 20709598
references.citation: J Neurol Sci. 2009 Mar 15;278(1-2):123-6
references.pmid: 19126443
references.citation: Br J Neurosurg. 1995 Apr;9(2):205-7
references.pmid: 7632368
references.citation: Surg Neurol. 2001 Jun;55(6):372-5
references.pmid: 11483200
references.citation: J Infect. 2009 Sep;59(3):167-87
references.pmid: 19643501
references.citation: Clin Neurol Neurosurg. 2006 Jun;108(4):353-7
references.pmid: 16644403
references.citation: J Clin Neurosci. 2013 Oct;20(10):1333-41
references.pmid: 23768968