By Ana Rocha-Cardoso, MD, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
A 78-year-old woman presented with a two-week history of diminished vision and sudden onset of complete ophthalmoplegia, ptosis, and loss of corneal sensation in her left eye. Fundus observation revealed a pale optic disc.
She had been prescribed an oral antibiotic three weeks earlier for symptoms compatible with sinusitis. The patient also had a previous history of chronic immunosuppression after a renal transplant 20 years ago (kidney failure due to drug toxicity).
The CT scan showed opacification of almost all the sinus cavities by material with soft tissue density, with mild to moderate, irregular enhancement after contrast administration. On the left there was involvement of the pterygopalatine fossa, inferior orbital fissure, and orbital apex. In the left orbit, the intraconal fat was obliterated by an amorphous mass, which infiltrated the medial and inferior rectus muscles and caused slight proptosis.
A biopsy was performed, and the patient was diagnosed with plasmocytic lymphoma.
This presentation of a primary lymphoma of the sinus cavities as an orbital apex syndrome is an unusual clinical picture, since this pathology does not usually present to the ophthalmologist. The patient died shortly after the diagnosis of an acute leukemic transformation of the lymphoma (one day after beginning chemotherapy).
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