title: Interesting case of base of skull mass infiltrating cavernous sinuses.
abstract: A man aged 35 years presented with chronic headache and earache of 1-year duration. He had progressive vision loss and diplopia since last 9 months. He also had pain over the face and episodic profuse epistaxis. On examination, perception of light was absent in the right eye and hand movements were detected at 4 m distance in the left eye. Imaging revealed a lobulated mass in the nasopharynx extending into the bilateral cavernous sinuses and sphenoid sinus with bony erosions. Biopsy of the nasopharyngeal mass revealed pathological features which are characteristic of IgG4 disease. His serum IgG4 levels and acute inflammatory markers were also elevated. The patient was started on oral corticosteroid therapy. Fever, headache and earache resolved early and there was gradual improvement in the vision of the left eye. After 6 months, visual acuity in the left eye was 6/9, but right eye visual acuity had no change. Follow-up imaging revealed a significant reduction in the size of the mass.
authors.affiliation: Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Achintya Dinesh
authors.initials: AD
authors.lastname: Singh
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Soneja
authors.affiliation: Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Saba Samad
authors.initials: SS
authors.lastname: Memon
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Surabhi
authors.initials: S
authors.lastname: Vyas
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002426:Cavernous Sinus / Q000473:pathology*; D004433:Earache / Q000175:diagnosis / Q000209:etiology; D005334:Fever / Q000175:diagnosis / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000209:etiology; D006261:Headache / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007154:Immune System Diseases / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D007074:Immunoglobulin G / Q000097:blood*; D007249:Inflammation / Q000097:blood / Q000209:etiology; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D009305:Nasopharynx / Q000473:pathology; D019291:Skull Base / Q000473:pathology*; D013101:Sphenoid Sinus / Q000473:pathology; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D014792:Visual Acuity
chemical_list: D000305:Adrenal Cortex Hormones; D007074:Immunoglobulin G; D018836:Inflammation Mediators