Wegener's granulomatosis with extension to the cavernous sinus

Wegener's granulomatosis (WG) is an uncommon inflammatory disease which rarely is reported to invade the cavernous sinus.

To report a case of cavernous sinus syndrome in a patient with longstanding pansinusitis who was found to have Wegener's granulomatosis.

A 59-year-old African American woman presented with a 10-day history of increasing nasal congestion with loss of taste and a 5-day history of increasing right frontal head pain with visual blurring of the right eye. On exam, she was noted to have diminished visual acuity, an afferent pupillary defect, and mild proptosis on the right, along with a palsy of the right sixth cranial nerve. She had a contrast-enhancing inflammatory process of the sinuses, the right pterygopalatine fossa, and the cavernous sinus by computed tomographic (CT) and magnetic resonance (MRI) scans.

Biopsy revealed a necrotizing granulomatous process compatible with Wegener's granulomatosis. She was switched from empiric anti-bacterial, anti-tuberculous, and anti-fungal therapy to prednisone and methotrexate.

Cavernous sinus involvement in Wegener's granulomatosis is rare, but such a disease process needs to be considered in the differential diagnosis of cavernous sinus syndrome as this will influence the choice of therapy.