A 42-year-old male presented with diplopia, rhinorrhea and headache seven months after diagnosis of serous media of the left ear.
Physical examination revealed paresis of the third and fourth left cranial nerves and amaurosis of the left eye.
Magnetic resonance imaging (MRI) of the brain showed a submucosal lesion of 3 cm in diameter in Meck's vum, with enhancement of the left submucous layer, affecting the left cranial base and the orbital fossa.
As well as a diffuse thickening of the meninges that enhances after contrast administration.
These findings were admitted to the Department of Otorhinolaryngology of the Hospital Clínico de Málaga for the study of the cavum lesion.
A brain MRI showed, in addition to the previously mentioned, an ischemic lesion in the head of the left caudate nucleus.
The biopsy of the cavum was reported intraoperatively as poorly differentiated tumor, probably carcinoma, and with the diagnosis of left cavum tumor, pending the definitive result of pathological anatomy, treatment was given to our center.
When the patient was admitted to the medical ward of our hospital, the biopsy was reported as chronic granulomatous inflammation, necrotizing, with langhan-type giant dye cells.
Two biopsies of cavum obtained acute and chronic inflammatory tissue, so dexamethasone was administered before performing a new biopsy.
When initiating treatment with corticosteroids, the pairs of cranial nerves were resolved and their general condition improved, so we commented on the case to complete the study of their disease.
At that time he presented normal constants and in the physical examination he only highlighted: pupil in middle mydriasis, little reactive, and amaurosis in the left eye, slight paresis of the lower plantar flexor limb indifferent left,
Blood analysis only showed normochromic normocytic anemia (Hb 8.1 mg/dl, MCV 85 mm leukocytes and MBC 31.8), neutrophilia 107 (13,200SG, 86% SG).
Urine analysis showed proteins, 20 leukocytes and abundant neutrophils/c; and 24-hour urine proteinuria was mild-30/1.
ANCA were positive for titre 1 positive anti-nociproteinase antibodies.
Toco-abdominal computed axial tomography (CAT) showed three cavitated pulmonary nodules, small focal liver and splenic lesions and bilateral renal lesions of ischemic appearance.
The neuroophthalmic study showed a complete left optic nerve defect and a complete afferent pupillary defect, while the visual evoked potentials showed a bilateral alteration of the visual cortex responses, more pronounced on the side.
The electromyography of the lower extremities revealed the existence of an axonal motor polyneuropa-tia.
Oral treatment was established with prednisone, 1 mg/kg, and cyclophosphamide, 2 mg/kg. At three months Hb 13.9 mg/dl, VSG 15 mm in the first hour, positive sedimentary antibody count/20um.
Follow-up was subsequently lost because the patient returned to Malaga.
