Orbital rhabdomyosarcoma in Li-Fraumeni syndrome.

trigeminal nerve. The patient subsequently died of a subarachnoid hemorrhage due to an aneurysm caused by Aspergillus infection. Although Aspergillus commonly originates in the lungs, more cases of paranasal sinus aspergillosis are being reported. It is possible that our patient had a paranasal sinus Aspergillus infection that extended into the orbital apex and carotid artery, although imaging studies did not indicate such an infection. The corticosteroid therapy, despite alleviating the symptoms,mayhaveexacerbated the infection and facilitated the resulting intracranial hemorrhage. Although somepatients survivewithaggressive earlytreatment,approximately60%of patients with central nervous system aspergillosisareeitherunsuccessfully treated or die. Painful ophthalmoplegia with visual loss merits careful evaluation. Although the underlying cause may not be apparent, the diagnosis of THS requires careful monitoring to ensure that other diseases have been excluded. The physician should have a low threshold to seek histopathologic clarification of the diagnosis.