scholarly journals Granulomatosis with Polyangiitis Presenting with Bilateral Orbital Apex Syndrome

2021 ◽  
pp. 32-40
Author(s):  
Yusuke Murai ◽  
Takuji Kurimoto ◽  
Sotaro Mori ◽  
Kaori Ueda ◽  
Mari Sakamoto ◽  
...  
Keyword(s):  
Visual Field ◽  
Eye Movement ◽  
Endoscopic Sinus Surgery ◽  
Granulomatosis With Polyangiitis ◽  
Field Tests ◽  
Sinus Surgery ◽  
Orbital Apex ◽  
Orbital Apex Syndrome ◽  
Initial Examination ◽  
Steroid Pulse

We report a rare case of granulomatosis with polyangiitis (GPA) presenting with bilateral orbital apex syndrome (OAS). A 73-year-old woman with a history of endoscopic sinus surgery for ethmoidal sinusitis experienced a sudden decrease in visual acuity (VA) of both eyes. At the initial examination, her VA had decreased to 0.01 in the right eye and 0.03 in the left eye, and eye movement in both eyes was mildly limited in all directions. Visual field tests of both eyes showed a large central scotoma. Laboratory tests revealed an elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody. Facial computed tomography demonstrated a thickened mucosal membrane in the entire ethmoidal sinus, and the posterosuperior walls of Onodi cells filled with infiltrative lesions had thinned. Orbital magnetic resonance imaging showed severe inflammation in the orbital apex. From these clinical findings, the patient was diagnosed with GPA presenting with OAS associated with ethmoid sinusitis. Emergent endoscopic sinus surgery was performed for biopsy and debridement of the ethmoidal and sphenoid sinusitis to decompress the optic nerve. One day after endoscopic sinus surgery, the patient’s VA and visual field were improved, and steroid pulse therapy was commenced postoperatively. Four days later, VA had recovered to 1.0 in both eyes, and eye movement and visual field had were improved. Although OAS is a rare manifestation, early surgical treatment should be considered when the orbital lesion presents as risk of rapid deterioration of visual function in patients with GPA.

Initial Presentation of Granulomatosis with Polyangiitis as Progressive Skull Base Osteomyelitis

ORL ◽  
2021 ◽  
pp. 1-5
Author(s):  
Hannan A. Qureshi ◽  
Anshu Bandhlish ◽  
Robert P. DeConde ◽  
Ian M. Humphreys ◽  
Waleed M. Abuzeid ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Granulomatosis With Polyangiitis ◽  
Abducens Nerve ◽  
Sinus Surgery ◽  
High Dose ◽  
Laboratory Findings ◽  
Skull Base Osteomyelitis ◽  
Antibody Positivity ◽  
Fluid Collections

A healthy man in his 30s presented with a 2-week history of severe bitemporal pain and pressure. He was initially treated for presumed acute rhinosinusitis, but his symptoms continued to worsen and underwent endoscopic sinus surgery at an outside community facility. He developed left abducens nerve palsy postoperatively, and magnetic resonance imaging (MRI) demonstrated evidence of extensive skull base osteomyelitis. He was initiated on intravenous (IV) broad-spectrum antibiotics but was subsequently found to have prostatic and submandibular sterile fluid collections. The patient subsequently developed new right abducens and left vagal nerve palsies and underwent revision endoscopic sinus surgery. Pathology revealed extensive inflammation, necrotizing granulomas, and evidence of small and medium vessel vasculitis. Extensive laboratory workup was negative, except for anti-PR-3 antibody positivity. Given the characteristic findings on pathology and laboratory findings, the patient was diagnosed with granulomatosis with polyangiitis (GPA). High-dose glucocorticoid therapy as well as rituximab infusion were promptly initiated. He had marked improvement in his symptoms and resolution of his right CN VI palsy but left-sided CN VI and CN X palsies persisted. This patient presented without the typical rhinologic manifestations of GPA, and rather presented with progressive sinusitis, skull base osteomyelitis with associated cranial neuropathies, and aseptic systemic abscesses. Prompt diagnosis of GPA is particularly important in those with otorhinolaryngological manifestations, as early initial immunosuppressive therapy has been linked to lower relapse and mortality rates. Vigilance and early differentiation between GPA and other forms of sinusitis is of critical importance, particularly when symptoms are refractory to standard rhinosinusitis therapies.

scholarly journals Orbital apex syndrome secondary to granulomatosis with polyangiitis

2013 ◽  
Vol 2013 (dec05 1) ◽  
pp. bcr2013009519-bcr2013009519 ◽  
Author(s):  
S. Siddiqui ◽  
A. J. Kinshuck ◽  
V. R. Srinivasan
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Orbital Apex ◽  
Orbital Apex Syndrome

Blindness due to electrocoagulation following functional endoscopic sinus surgery

1996 ◽  
Vol 110 (3) ◽  
pp. 261-264 ◽  
Author(s):  
D. Vanden Abeele ◽  
A. Clemens ◽  
M. J. Tassignon ◽  
P. H. van de Heyning
Keyword(s):  
Visual Field ◽  
Endoscopic Sinus Surgery ◽  
Recent Literature ◽  
Rare Complication ◽  
Functional Endoscopic Sinus Surgery ◽  
The Other ◽  
Sinus Surgery ◽  
Delayed Bleeding ◽  
Irreversible Blindness

AbstractA case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under conditions of poor visualization, that may be the case in post-operative bleeding following (endoscopic) sinus surgery, is strongly discouraged.

ANCA-negative granulomatosis with polyangiitis presenting with orbital apex syndrome and recurrent pachymeningitis: A case report

2016 ◽  
Vol 368 ◽  
pp. 175-177 ◽  
Author(s):  
Shin Hisahara ◽  
Minoru Yamada ◽  
Yousuke Matsuura ◽  
Emiko Tsuda ◽  
Yukinori Akiyama ◽  
...  
Keyword(s):  
Case Report ◽  
Granulomatosis With Polyangiitis ◽  
Orbital Apex ◽  
Orbital Apex Syndrome

Ophthalmic Complications after Surgery for Nasal and Sinus Polyposis

2001 ◽  
Vol 11 (3) ◽  
pp. 218-222 ◽  
Author(s):  
P. Vassallo ◽  
F. Tranfa ◽  
R. Forte ◽  
A. D'Aponte ◽  
D. Strianese ◽  
...  
Keyword(s):  
Extraocular Muscle ◽  
Muscle Injury ◽  
Early Recognition ◽  
Endoscopic Procedure ◽  
Sinus Surgery ◽  
Orbital Apex ◽  
Orbital Apex Syndrome ◽  
Fourth Case ◽  
Orbital Complications

Purpose To describe ophthalmic complications after nasal and sinus surgery. Methods Four cases with orbital complications were retrospectively selected from among more than 2000 cases of orbital pathologies. Results Motility disturbances due to extraocular muscle injury occurred in two patients after intranasal ethmoidectomy and in one patient after a Caldwell-Luc procedure. In the fourth case an orbital apex syndrome was noted after intranasal ethmoidectomies. Conclusions Ophthalmic complications may occur after nasal and sinus surgery, even using an endoscopic procedure. Successful handling of these complications could be reached by on their early recognition and treatment.

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