IntroductionPainful ophthalmoplegia refers to periorbital or hemicraneal pain plus ipsilateral ocular motor nerve palsies with or without oculo-sympathetic paralysis, sensory loss in the distribution of V1 and V2 can co-occur. There are many etiologies of painful ophthalmoplegia. Tolosa-Hunt syndrome is a steroid-responsive painful ophthalmoplegia secondary to idiopatic granulomatous inflammation of the cavernous sinus or orbital apex. THS is a diagnosis of exclusion and treatment should be with high dose steroid.Case presentationWe describe the case of a 19-year-old female that was admitted to our hospital for painful ophthalmoplegia of the left eye. After the diagnostic work-up, we concluded that the patient had a benign form of Tolosa-Hunt syndrome. We initiated treatment with steroids and 72 hours later saw a response.ConclusionIn conclusion, steroid treatment is the cornerstone in the management of THS. Even though there is no standardized dose specified in the literature, this type of treatment with steroids at a dose of 1 mg/kg/day tapered slowly over 3 to 4 months has been well received.

RESUMENConsiderando la alta incidencia de vulvovaginitis en la consulta de ginecología pediátrica y de adolescentes, y los aspectos únicos de la microbiología y endocrinología de la paciente prepúber se presenta una revisión de la literatura con lo más relevante de los últimos 5 años, en lo que se refiere a epidemiología, etiología, diagnóstico y tratamiento de la vulvovaginitis bacteriana específica de la niña prepúber. No existe claridad acerca de la microflora vaginal normal, lo cual dificulta en gran medida la interpretación de muestras. De acuerdo con la evidencia actual podemos decir que ante la vulvovaginitis específica de la prepúber debemos tener en consideración como principales agentes causales: patógenos respiratorios, epidérmicos y entéricos; higiene defectuosa, cuerpos extraños, irritantes, enfermedades dermatológicas vulvares, defectos anatómicos y abuso sexual. Streptococcus hemolitico del grupo A y Haemophilus influenzae son patógenos prevalentes. PALABRAS CLAVE: Vulvovaginitis, prepúber, bacterias vaginales SUMMARYHaving into account the high frequency of vulvovaginitis in the pediatric and adolescent gynecology setting and the unique aspects of the microbiology and endocrinology of the pre pubertal patient, we present a review of the most relevant aspects in the last 5 years, concerning epidemiology, etiology, diagnosis and treatment of specific bacterial vulvovaginitis in the pre pubertal girl. There's no consensus regarding the normal vaginal microflora, which makes difficult the interpretation of swabs. According to actual evidence we could say that in approaching prepubertal vulvovaginitis we must consider as main etiologic agents: respiratory, enteric and epidermic pathogens; deficient hygiene, foreign bodies, irritants, vulvar dermatologic diseases, anatomical abnormalities and sexual abuse. Group A -hemolytic Streptococcus and Haemophilus influenzae are prevalent pathogens.