Acute monocular visual loss in carcinomatous hypertrophic pachymeningitis mimicking giant cell arteritis

Abstract

This report describes a 69-year-old woman who presented with acute monocular visual loss, ipsilateral headache, and elevated sedimentation rate (ESR) and C-reactive protein (CRP). Both temporal artery biopsies were negative. Neuroimaging, dural biopsy, and breast biopsy all confirmed the diagnosis of carcinomatous hypertrophic pachymeningitis associated with metastatic breast carcinoma. After treatment with corticosteroids, her vision improved. Her clinical presentation initially mimicked the symptoms and signs of giant cell arteritis. Acute monocular visual loss without other cranial nerve palsies may be an uncommon presentation of hypertrophic pachymeningitis from metastatic breast carcinoma.

Multifocal Fibrosclerosis with Hypertrophic Pachymeningitis and a Soft Tissue Mass around the Thoracic Vertebral Bodies: A Case Report with Review of the Literature

“…Several causes have been recognized, including infections (tuberculosis and fungi), tumors, autoimmune diseases (granulomatosis with polyangiitis: GPA), and sarcoidosis (1)(2)(3). Multifocal fibrosclerosis is the term used to represent a combination of similar fibrous lesions occurring at different anatomical sites (4), and some conditions in this disease overlap with those of IgG4-related disease.…”