Purpose: To evaluate a case of orbital actinomycosis presenting as Tolosa-Hunt syndrome in a patient with a history of carcinomas of the kidney and breast. Methods: A woman with ingravescent painful ophthalmoplegia was brought to our observation. Brain and orbital and total body CT scans showed the presence of two orbital neoformations and a miliary pattern of dissemination in the lung. The initial diagnosis, which pointed to secondary localisations of the previous kidney and breast tumours, was changed to orbital and pulmonary actinomycosis following microbiological analysis of lung biopsy samples. Results: Prolonged antibiotic therapy with synthetic penicillin completely resolved the case. Conclusions: Actinomycosis is a very rare infection that may also affect the orbit and its association with a pulmonary dissemination is highly unusual. It is important to consider this type of infection among the causes of painful ophthalmoplegia.

McLeod SD: Infectious keratitis; in Yanoff M, Duker JS (eds): Ophthalmology. St Louis, Mosby, 2004, pp 466–491.
Dentale N, Fulgaro C, Fasulo G, Guerra L, Legnani G, Mazzetti M, Poletti V, Gritti FM: Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin’s lymphoma. Scand J Infect Dis 1998;30:519–520.
Nithyanandam S, D’Souza O, Rao SS, Battu RR, George S: Rhinoorbitocerebral actinomycosis. Ophthal Plast Reconstr Surg 2001;17:134–136.
Burns BV, al-Ayoubi A, Ray J, Schofield JB, Shotton JC: Actinomycosis of the posterior triangle: a case report and review of the literature. J Laryngol Otol 1997;111:1082–1085.
Hussain I, Bonshek RE, Loudon K, Armstrong M, Tullo AB: Canalicular infection caused by actinomyces. Eye 1993;7:542–544.
McKellar MJ, Aburn NS: Cast-forming Actinomyces israelii canaliculitis. Aust NZ J Ophthalmol 1997;25:301–303.
Hass C, Pittasch K, Handrick W, Tauchnitz R: Actinomycetes canaliculitis – case reports. Immun Infekt 1995;23:222–223.
Shauly Y, Nachum Z, Gdal-On M, Melamed Y, Miller B: Adjunctive hyperbaric oxygen therapy for actinomycotic lacrimal canaliculitis. Graefes Arch Clin Exp Ophthalmol 1993;231:429–431.
Sullivan TJ, Aylward GW, Wright JE: Actinomycosis of the orbit. Br J Ophthalmol 1992;76:505–506.
Karcioglu ZA: Actinomyces infection in porous polyethylene orbital implant. Graefes Arch Clin Exp Ophthalmol 1997;235:448–451.
Scarano FJ, Ruddat MS, Robinson A: Actinomyces viscosus postoperative endophthalmitis. Diagn Microbiol Infect Dis 1999;34:115–117.
Garelick JM, Khodabakhsh AJ, Josephberg RG: Acute postoperative endophthalmitis caused by Actinomyces neuii. Am J Ophthalmol 2002;133:145–147.
Roussel TJ, Olson ER, Rice T, Meisler D, Hall G, Miller D: Chronic postoperative endophthalmitis associated with Actinomyces species. Arch Ophthalmol 1991;109:60–62.
Singh M, Kaur B: Actinomycetic corneal ulcer. Eye 1989;3:460–462.
Kline LB, Hoyt WF: The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry 2001;71:577–582.
Vrabec MP, Florakis GJ: Actinomyces organisms in ocular disease; in Duane’s Ophthalmology on CD-ROM. Philadelphia, Lippincott Williams & Wilkins, 2000.
Brod RD, Clarkson JG, Flynn HW, Green RW Jr: Rare causes of endogenous fungal endophthalmitis; in Duane’s Ophthalmology on CD-ROM. Philadelphia, Lippincott Williams & Wilkins, 2000.
Baum JL: Antibiotic use in ophthalmology; in Duane’s Ophthalmology on CD-ROM. Philadelphia, Lippincott Williams & Wilkins, 2000.
Mezer E, Gdal-On M, Miller B: Orbital metastasis of renal cell carcinoma masquerading as amaurosis fugax. Eur J Ophthalmol 1997;7:301–304.
Bersani TA, Costello JJ Jr, Mango CA, Streeten BW: Benign approach to a malignant orbital tumor: metastatic renal cell carcinoma. Ophthal Plast Reconstr Surg 1994;10:42–44.
Schmidt M, Schmidt T, Ugi I: Orbital metastasis of kidney carcinoma. Klin Monatsbl Augenheilkd 1994;205:40–43.
Parnes RE, Goldberg SH, Sassani JW: Renal cell carcinoma metastatic to the orbit: a clinicopathologic report. Ann Ophthalmol 1993;25:100–102.
Harnett AN, Kemp EG, Fraser G: Metastatic breast cancer presenting as Tolosa-Hunt syndrome. Clin Oncol 1999;11:407–409.
Burmeister BH, Benjamin CS, Childs WJ: The management of metastasis to eye and orbit from carcinoma of the breast. Aust NZ J Ophthalmol 1990;18:187–190.
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