Kazuhiko Endo

Eosinophilic colitis accompanied by Tolosa–Hunt syndrome: report of a case

presented in this case has been documented only rarely.1–3 With regard to laboratory findings, peripheral hypereosinophilia and elevation of serum IgE levels occur variably and are not reliable prerequisites for diagnosis.1,2 Because definite diagnosis requires microscopic evidence, multiple biopsies by endoscopy or fullthickness biopsies by minimal invasive surgery such as laparoscopy should be considered.2,4 The most interesting symptom seen in this case was painful ophthalmoplegia, which is produced by involvement of the cranial nerves passing through the cavernous sinus. This case was thought to be THS from his clinical course, the diagnosis of which is made only after other possible diseases, such as tumors and aneurysm, have been excluded. The etiology of THS is poorly understood, although the pathology is considered to be a non-specific granulomatous inflammation in the region of the cavernous sinus.5 Corticosteroids are the mainstay of treatment for EGE1,3,4 as well as for THS,5 and surgery is reserved for medically refractory EGE, usually either obstructive or perforated cases.1,4 In this case, it is possible that initial administration of corticosteroids could have prevented surgical intervention and provided relief from all symptoms. To the best of our knowledge, this is the first case of eosinophilic colitis and THS coexisting, probably merging accidentally.