Pediatric Recurrent Unilateral Trochleitis in Association With Paranasal Sinusitis: A Case Report

Abstract

Trochleitis is an easily treatable condition; however, it is often misdiagnosed by many clinicians because of its rare incidence. We report the case of a 14-year-old Saudi male patient, known to have type 1 diabetes mellitus (DM) and pansinusitis, who presented to the emergency department with a one-day history of severe right periorbital pain exacerbated by upgaze and supraduction. There was intense point tenderness on palpation over the trochlear region of the orbit with no underlying swelling or redness. Both eyes had a corrected visual acuity of 0.8. Mildly limited elevation (-1) of the right eye was noted. All other extraocular movements were normal in both eyes. Contrast-enhanced CT of the head and orbits showed mild trochlear swelling, inflammation, and pansinusitis. He was treated with a single intratrochlear injection of steroids, which immediately and significantly improved the symptoms. To the best of our knowledge, this is the second case of trochleitis associated with paranasal sinusitis in children. This suggests that a possible, but rare, association between these two conditions may exist in the pediatric population.

Chronic Unilateral Idiopathic Trochleitis Misdiagnosed With Migraine in an 18-Year-Old Male: A Case Report

“…All the authors emphasized that trochleitis demonstrates a constellation of features: orbital pain aggravated by vertical eye movement, especially adduction, tenderness in the central area of the trochlea, and signs of inflammation, including swelling of the superior oblique muscle [1][2][3][4][5][6][7][8]. Our patient exhibited all of these features.…”

“…A retrospective study conducted by Jarrín et al suggested that NSAIDs are effective when pain is the sole symptom [ 3 ]. The most effective treatment primarily involved injectable short-acting or long-acting corticosteroids [ 2 , 3 , 5 , 6 ]. Similarly, in our case, NSAIDs did not alleviate the pain.…”

“…It was first identified in 1984 by Tychsen et al, who studied 13 patients diagnosed with trochleitis [4]. Subsequently, a few papers reported on an additional 118 patients in both adult and pediatric age groups [1][2][3][5][6][7].…”