Rev Bras Oftalmol.2025;84:e0099
Tolosa-Hunt syndrome after chikungunya infection
DOI: 10.37039/1982.8551.20250099
ABSTRACT
This case report aimed to describe the Tolosa-Hunt syndrome in a patient infected with chikungunya and highlight the relevance of considering chikungunya as a possible cause of the Tolosa-Hunt syndrome, especially in endemic or epidemic infection sites. A 63-year-old female patient diagnosed with chikungunya 2 months earlier was being followed up by a general practitioner. She had painful ophthalmoplegia associated with eyelid ptosis in the left eye (LE) for 1 month. Intraocular pressure (IOP) of 20 and 26 mmHg. Patient was prescribed 1 drop of Timolol maleate 0.5% every 12 hours and prednisone 60mg/day for 14 days. Two weeks later, the painful ophthalmoplegia resolved and the eyelid ptosis improved. Computed tomography (CT) scan of the skull and orbits revealed left orbital proptosis with thickening of the lateral and superior rectus muscle and the muscle belly at its tendinous insertion, erythrocyte sedimentation value (ESV) 42, and positive serology for IgG and IgM antibodies to chikungunya was positive. Treatment was then changed to prednisone 40mg/day for seven days, decreasing every seven days, and timolol maleate was discontinued. This case highlights the necessity of including chikungunya as a possible cause of Tolosa-Hunt Syndrome (THS) in endemic or epidemic infection sites, guaranteeing an early diagnosis and appropriate treatment.
