Orbital apex syndrome without MRI lesion caused by ANCA-associated vasculitis

Bilateral Orbital Apex Syndrome Due to Granulomatosis with Polyangiitis

“…In fact, to our knowledge, there has been only one previously reported case of ANCAassociated vasculitis causing OAS without corresponding radiographic abnormalities detected on MRI. 10 Second, despite a suspicion of systemic vasculitis given a mild sensory mononeuritis multiplex, an orbital biopsy was required to establish a definite histopathologic diagnosis. Finally, although the optic neuropathy and oculomotor dysfunction were severe at presentation, recovery to normal acuity and ductions demonstrates the robust long-term response to immunosuppression in this condition.…”