Tolosa hunt syndrome following dengue infection: A case report

Abstract Tolosa Hunt Syndrome (THS) is considered a rare disorder and is thought to be a form of unspecific inflammation of the cavernous sinus. One of the most common risk factors for THS is a recent viral infection. Dengue virus’s ability to cross the blood–brain barrier was reported many years ago, and encephalitis was one of the most common neurological manifestations of severe dengue infection. High dose of glucocorticoid is the main therapy for THS, but there is no specific guideline about dose recommendation, duration, and route of administration. A 32-year-old man was admitted to the hospital with the diagnosis of Dengue Hemorrhagic Fever. On the second day of hospitalization, the patient experienced sudden diplopia, especially when gazing to the right side, and sudden right temporal pain. On physical examination, there was ptosis of the right eye, negative light reflex, and paresis of NIII, NIV, and NVI of the right eye. The magnetic resonance imaging result showed an intense homogenously enhancing lesion on the right anterior cavernous to the right orbital apex. We reported the first case of THS with a preceding dengue virus infection. The nonspecific inflammatory process of the cavernous sinus could be idiopathic, or might be caused by a viral infection. It is possible that dengue virus infection might cause the inflammation in THS, but this needs further research. High-dose corticosteroids are still the first-line treatment for THS.