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A simultaneous occurrence of Tolosa–Hunt syndrome and fibrillary glomerulonephritis: a case report
  1. A Gigante1,
  2. K Giannakakis2,
  3. M Visentini3,
  4. M Fiorilli3,
  5. B Barbano1,
  6. R Renzulli1,
  7. F Borghesi1,
  8. R Cianci1
  1. 1
    Department of Nephrology, University “La Sapienza”, Rome, Italy
  2. 2
    Department of Experimental and Pathology, University “La Sapienza”, Rome, Italy
  3. 3
    Department of Immunology, University “La Sapienza”, Rome, Italy
  1. Professor Rosario Cianci, Department of Nephrology, First Faculty of Medicine, University of Rome “La Sapienza”, Viale dell’Università, 37, 00185, Rome, Italy; ciancirosario{at}


Fibrillary glomerulonephritis (FibGN) is a rare cause of progressive renal dysfunction, often leading to dialysis within a few years. A 60-year-old woman presented with a 2 month history of right-sided retro-orbital pain and recent diplopia. Laboratory testing revealed an altered renal function with increased serum creatinine and mild proteinuria. MRI of the brain revealed the presence of a soft tissue mass on the right cavernous sinus compatible with the diagnosis of Tolosa–Hunt syndrome (THS). Renal biopsy showed a pattern compatible with fibrillary glomerulonephritis. For this reason steroid therapy was initiated at a dose of 1 mg/kg/day and adjusted according to the clinical course. Neurological symptoms regressed shortly after the beginning of therapy and renal function and proteinuria remained stable for the 3 years following the withdrawal of steroid therapy. Percutaneous renal biopsy was again performed and confirmed the previous diagnosis of FibGN in association with other glomerular-lesion-like mesangial widening, thickening of capillary walls and severe arterio-arteriolosclerosis. This case report describes what is believed to first report of the association of FibGN and THS, which both responded to steroid therapy.

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  • Competing interests: None.

  • Patient consent: Obtained.