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Related Experiment Videos

Blow.

M Tariq Bhatti1, Jeffrey G Moore2, Thomas N Hwang3

  • 1The Permanente Medical Group, Department of Ophthalmology, Kaiser Permanente-Northern California, Roseville, CA, USA.

Survey of Ophthalmology
|May 16, 2025
PubMed
Summary
This summary is machine-generated.

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A patient initially suspected of giant cell arteritis was diagnosed with cocaine-induced midline destructive lesions after imaging revealed orbital and sinus masses. This case highlights the importance of considering substance abuse in midline destructive lesions.

Area of Science:

  • Ophthalmology
  • Neurology
  • Toxicology

Background:

  • Giant cell arteritis (GCA) can present with orbital and sinus symptoms, but diagnosis can be challenging, especially with negative biopsies.
  • Midline destructive lesions (MDLs) encompass a range of conditions affecting the orbit, sinuses, and nasal cavity, with diverse etiologies.
  • Cocaine abuse is an underrecognized cause of MDLs, often mimicking other inflammatory or neoplastic processes.

Purpose of the Study:

  • To present a case of a 59-year-old woman with symptoms initially suggestive of GCA.
  • To illustrate the diagnostic challenges and imaging findings associated with cocaine-induced midline destructive lesions.
  • To emphasize the importance of a thorough patient history, including substance use, in diagnosing complex orbital and sinus pathologies.

Main Methods:

Keywords:
ANCACocaineMidlineOrbital inflammation

Related Experiment Videos

  • Clinical presentation of headache, diplopia, and elevated inflammatory markers.
  • Initial negative temporal artery biopsy and treatment for suspected GCA.
  • Review of CT angiography and MRI demonstrating orbital mass and paranasal sinus disease.
  • ANCA testing and intranasal biopsy.
  • Patient history revealing intranasal cocaine use.

Main Results:

  • Initial presentation mimicked GCA with periorbital headache and elevated inflammatory markers.
  • Imaging revealed a right medial orbital mass with medial orbital wall disruption and paranasal sinus opacification.
  • Despite negative temporal artery biopsy and treatment for GCA, symptoms persisted.
  • Diagnosis of cocaine-induced midline destructive lesions was confirmed after identifying intranasal cocaine use.

Conclusions:

  • Cocaine-induced midline destructive lesions can present with symptoms mimicking other conditions like GCA.
  • Multimodality imaging is crucial for identifying orbital and sinus involvement in MDLs.
  • A comprehensive patient history, including illicit substance use, is essential for accurate diagnosis and management of destructive inflammatory conditions.