When Fire Meets Shadow: A Rare Case of Tolosa-Hunt Syndrome Associated with Discoid Lupus Erythematosus

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DOI:

https://doi.org/10.5195/ijms.2025.3130

Keywords:

Tolosa-Hunt Syndrome, Discoid Lupus Erythematosus, Painful Ophthalmoplegia, Cavernous Sinus Syndrome, Corticosteroid Therapy, Auto-immune disorder, Immunosupressive Therapy

Abstract

Background: Tolosa-Hunt Syndrome (THS) is a rare inflammatory disorder presenting with painful ophthalmoplegia due to granulomatous involvement of the cavernous sinus or superior orbital fissure. Though autoimmune diseases such as systemic and discoid lupus erythematosus (SLE/DLE) are known to overlap with other disorders, their association with THS remains poorly documented. DLE, a chronic photosensitive condition with scarring skin lesions, is particularly rare in conjunction with THS. This report explores a case of THS associated with DLE, highlighting diagnostic complexities and therapeutic strategies.

Case: A 54-year-old woman presented with right-sided headache, diplopia, and ocular pain. Examination revealed right third cranial nerve palsy, hyperpigmented macular lesions, and alopecia areata. Imaging demonstrated cavernous sinus inflammation, and laboratory findings included elevated ESR, positive dsDNA titers, and a homogeneous immunofluorescence pattern. A biopsy confirmed DLE, aligning with clinical and imaging findings of THS. The patient was treated with corticosteroids and mycophenolate mofetil, resulting in sustained symptom resolution with no relapse during follow-up.

Conclusion: This case underscores the need to consider autoimmune conditions like DLE in patients with THS, suggesting a possible shared autoimmune mechanism. Early recognition and timely initiation of immunosuppressive therapy with corticosteroids and mycophenolate mofetil were key to achieving remission, supporting their use as first-line treatment. This report adds to the limited literature on DLE-associated THS and highlights the importance of thorough diagnostic evaluation and long-term follow-up to monitor progression and prevent recurrence. Additional reports are needed to improve understanding of the pathophysiology, clinical features, and optimal management of these rare coexisting conditions.

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The image is an axial magnetic resonance (MR) scan of the brain, capturing the posterior fossa and the orbits. This transversal view clearly shows the cerebellar hemispheres and the brainstem centrally, along with both eyeballs and their extrinsic muscles. Based on the signal intensity, the sequence appears to be T1-weighted, possibly post-contrast or a fat-suppressed sequence. From this single snapshot, no large, obvious focal lesions are identified within the structures of the posterior fossa.

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Published

2025-07-29 — Updated on 2025-09-17

How to Cite

Chozhan M, Srinivasan, G., P, V., & Sankaranarayanan, L. (2025). When Fire Meets Shadow: A Rare Case of Tolosa-Hunt Syndrome Associated with Discoid Lupus Erythematosus. International Journal of Medical Students, 13(3), 333–336. https://doi.org/10.5195/ijms.2025.3130

Issue

Vol. 13 No. 3 (2025)

Section

Case Report

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Copyright (c) 2025 Chozhan M, Gurunathan Srinivasan, Vishaal P, Lakshmanan Sankaranarayanan

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