Great masquerader in Pandora's box: A case of orbital TB

Orbital tuberculosis is rare, even in endemic areas. A 45-year-old male diabetic presented with drooping of the right eyelid and facial pain for one month. He was diagnosed with Tolosa–Hunt syndrome elsewhere and treated with systemic steroids with poor response. He was diagnosed with right anterior cavernous syndrome with possible etiologies of Tolosa–Hunt syndrome, tuberculosis, meningioma, and sarcoid. GeneXpert for tuberculosis from the sputum sample was positive. On magnetic resonance imaging brain, a small 7-8 mm extra enhancing lesion was noted in the right cavernous sinus. Biopsy could not be done due to the site of the lesion which was technically difficult and dangerous. We started the patient on antituberculous therapy and steroids after consulting the physician; within 1 week there was a drastic improvement in ptosis and ophthalmoplegia.