Article in Japanese

Bilateral Tolosa-Hunt syndrome in a child after group A streptococcal infection

Taku Kondo^1）, Yoshihiko Kawano^1）, Shuhei Mizutani^1）, Shiho Iwase^1）, Shinya Hara^1）

Tolosa-Hunt syndrome （THS） is characterized by unilateral orbital pain associated with paresis of the third, fourth and/or sixth cranial nerves. This study reports a case of bilateral THS following group A Streptococcus （GAS） infection.
A 7-year-old boy presented with right temporal pain lasting for 3 weeks. Laboratory findings showed a high antistreptolysin O （ASO） titer, and a throat culture identified Streptococcus pyogenes. On day 4 of admission, he developed right abducens nerve palsy, diplopia, left temporal pain, intermittent abdominal pain, and palpable purpura on the lower legs. He was diagnosed with IgA vasculitis and started on prednisolone, which improved his symptoms. Magnetic resonance imaging （MRI） revealed an abnormal tissue in the right cavernous sinus and right internal carotid artery stenosis. The abnormal tissue enhanced markedly with contrast, and he was diagnosed with THS.
Although the etiology of THS remains unknown, cases associated with autoimmune diseases, COVID-19, and COVID-19 vaccination have been reported. GAS is known to trigger autoimmune diseases, including acute rheumatic fever. This case suggests that GAS infection may trigger THS.

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1）Department of Pediatrics, Toyota Memorial Hospital

Key words	Tolosa-Hunt syndrome, Group A Streptococcus, headache, diplopia
Received	August 5, 2025
Accepted	December 26, 2025

38 (1)：13─18,2026