Aspergillus infection of the orbital apex masquerading as Tolosa-Hunt syndrome.

Painful ophthalmoplegia can be caused by numerous pathologic conditions such as aneurysm; neoplasms such as chondrosarcoma, lymphoma, and nasopharyngeal carcinoma; diabetes mellitus; infection; and inflammatory disorders such as sarcoidosis and TolosaHunt syndrome (THS). Described by Tolosa in 1954 and Hunt et al in 1961, THS is an idiopathic, selflimited inflammatory disorder characterized by painful ophthalmoplegia that has a rapid response t o s y s t e m i c c o r t i c o s t e r o i d therapy. We describe a patient who initially appeared to have THS but at autopsy was found to have an Aspergillus infection that involved the carotid artery and caused her death.