Original Research

HIV-associated cavernous sinus disease

Cait-lynn D. Wells, Anand A. Moodley
Southern African Journal of HIV Medicine | Vol 20, No 1 | a862 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.862 | © 2019 Cait-lynn Wells, Anandan A. Moodley | This work is licensed under CC Attribution 4.0
Submitted: 25 April 2018 | Published: 20 March 2019

About the author(s)

Cait-lynn D. Wells, Department of Neurology, Greys Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Anand A. Moodley, Department of Neurology, Universitas Hospital, University of the Free State, Bloemfontein, South Africa


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Abstract

Introduction: The underlying diagnosis of cavernous sinus disease is difficult to confirm in HIV-coinfected patients owing to the lack of histological confirmation. In this retrospective case series, we highlight the challenges in confirming the diagnosis and managing these patients.

Results: The clinical, laboratory and radiological data of 23 HIV-infected patients with cavernous sinus disease were analysed. The mean age of patients was 38 years. The mean CD4+ count was 390 cells/μL. Clinically, patients presented with unilateral disease (65%), headache (48%), diplopia (30%) and blurred vision (30%). Third (65%) and sixth (57%) nerve palsies in isolation and combination (39%) were most common. Isolated fourth nerve palsy did not occur. Tuberculosis (17%) was the most commonly identified disorder followed by high-grade B-cell lymphoma (13%), meningioma (13%), metastatic carcinoma (13%) and neurosyphilis (7%). In 22% of the patients, there was no confirmatory evidence for a diagnosis. The patients were either treated empirically for tuberculosis or improved spontaneously when antiretroviral therapy was started. Cerebrospinal fluid was helpful in 4/13 (31%) of patients where it was not contraindicated. Only 3/23 (13%) of the patients had a biopsy of the cavernous sinus mass. The outcomes varied, and follow-up was lacking in the majority of patients.

Conclusion: In HIV-infected patients, histological confirmation of cavernous sinus pathology is not readily available for various reasons. In resource-limited settings, one should first actively search for extracranial evidence of tuberculosis, lymphoma, syphilis and primary malignancy and manage appropriately. Only if such evidence is lacking should a referral for biopsy be considered.


Keywords

cavernous sinus disease; HIV infection; CNS tuberculosis; neurosyphilis; lymphoma

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