HIV-associated cavernous sinus disease
Southern African Journal of HIV Medicine
| Field | Value | |
| Title | HIV-associated cavernous sinus disease | |
| Creator | Wells, Cait-lynn D. Moodley, Anand A. | |
| Description | 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. | |
| Publisher | AOSIS | |
| Date | 2019-03-20 | |
| Identifier | 10.4102/sajhivmed.v20i1.862 | |
| Source | Southern African Journal of HIV Medicine; Vol 20, No 1 (2019); 7 pages 2078-6751 1608-9693 | |
| Language | eng | |
| Relation |
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:
https://sajhivmed.org.za/index.php/hivmed/article/view/862/1341
https://sajhivmed.org.za/index.php/hivmed/article/view/862/1340
https://sajhivmed.org.za/index.php/hivmed/article/view/862/1342
https://sajhivmed.org.za/index.php/hivmed/article/view/862/1339
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