CASE REPORT article
Front. Pediatr.
Sec. Pediatric Infectious Diseases
Volume 13 - 2025 | doi: 10.3389/fped.2025.1663784
This article is part of the Research TopicTuberculosis and Immune RegulationView all 4 articles
Atypical Extensive orbitofacial tuberculosis to the skull base and cavernous sinus revealing a major histocompatibility complex class II deficiency in an 11-year-old girl : a case report
Provisionally accepted
- Military Hospital of Tunis, Tunis, Tunisia
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Background : Cavernous sinus tuberculosis is an extremely rare manifestation of central nervous system tuberculosis in children, with only two cases reported worldwide. It can mimic malignancy or other inflammatory conditions. Its occurrence in children with primary immunodeficiency, particularly major histocompatibility complex (MHC) class II deficiency, has not yet been described. Case report : We report an 11-year-old girl with a history of recurrent infections and chronic otitis media. She presented with right orbital swelling, severe headaches, and exophthalmos. Imaging revealed an extensive mass in the sinonasal and orbital regions, extending to the skull base and cavernous sinus. Computed tomography–guided biopsy and histopathology, supported by PCR testing for Mycobacterium tuberculosis, confirmed extensive orbital and cervicofacial tuberculosis. Immunological evaluation and genetic analysis revealed familial MHC class II deficiency. The patient received antituberculous therapy (HRZE followed by HR), leading to clinical and radiologic improvement. She continues intravenous immunoglobulin replacement every 21 days while awaiting bone marrow transplantation. Conclusions : This case highlights the importance of considering tuberculosis in atypical cavernous sinus lesions in children, especially in endemic regions. Severe or unusual infections should prompt evaluation for underlying immunodeficiency.
Keywords: Cavernous Sinus, MHC class II deficiency, pediatric case report, Orbital tuberculosis, paranasal sinus tuberculosis
Received: 10 Jul 2025; Accepted: 09 Oct 2025.
Copyright: © 2025 Mezri, Amri, Essghaier, Tlili, Rabhi, Marmouri and Barakizou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sameh Mezri, samehmezri@yahoo.fr
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