(078) Cavernous Thrombosis Revealing Sinus Tuberculosis: A Case Report

Introduction: Tuberculosis is still endemic in developing countries due to Mycobacterium tuberculosis and the lung is its privileged place. Naso-sinus localization is rare, characterized by clinical polymorphism and non-specific symptomatology, posing a problem of differential diagnosis.

Methods: We report in this publication a case of cavernous thrombosis revealing sinus tuberculosis in a 42-year-old patient, garbage collector, diabetic, who consulted in the emergency department for left orbital swelling with insomnia headaches. The ENT clinical examination found ptosis of the left eye and non-reducible axile proptosis, fever at 38°5 and purulent rhinorrhea from the left middle meatus. The ophthalmological examination found negative light perception, complete ophthalmoplegia, arereflectic mydriasis and inter-maculo-papillary retinal ischemia. Naso-sinus imaging by CT shows almost total filling of the ethmoidal cells and the left maxillary sinus. Cerebro-orbital MRI found left cavernous thrombophlebitis with dilation of the ophthalmic vein, right internal conical intra and extra abscessed collection sheathing the right muscle, the optic nerves in their posterior portions and a small internal temporal empyema. The patient was hospitalized in our department, put on triple antibiotic therapy: cefotaxime, ciprofloxacin and metronidazole with anticoagulation at a curative dose for 3 weeks but without clinical improvement.

Results: Our patient underwent surgery by combined endoscopic and external approach. The histopathological study of biopsy specimens found a respiratory tissue site of epithelio-giganto-cellular granulomatous inflammatory lesion evoking tuberculosis. The patient was put on anti-tuberculosis treatment: 2RHZ /4RH with a good clinical and biological evolution. The patient kept sequelae: ptosis and permanent left blindness.

Conclusions: Sinus tuberculosis is characterized by its rarity and clinical polymorphism. It is necessary to know how to evoke it in front of any trailing semiology under usual treatment, in order to establish an early effective therapy.