Purpose

To present a rare case of sinonasal Ewing sarcoma mimicking an upper respiratory tract infection, leading to rapidly progressive bilateral vision loss due to orbital and optic pathway invasion.

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Methods

A 17-year-old female presented with nasal obstruction and headache and was initially treated for a presumed upper respiratory tract infection. Due to lack of response to treatment and worsening symptoms, cranial imaging was performed and revealed a mass occupying the left nasal cavity with skull base invasion, and biopsy was performed. A definitive diagnosis could not be established at the initial center, and the patient was referred with differential diagnoses of rhabdomyosarcoma, olfactory neuroblastoma, and other small round blue cell tumors. Vision loss developed in the left eye during the interval prior to admission to our clinic. On initial examination, best-corrected visual acuity was 20/20 in the right eye, while there was no light perception in the left eye, accompanied by marked proptosis. Fundus examination of the left eye showed optic disc pallor consistent with optic atrophy. Subsequent imaging demonstrated the mass invaded the left maxillary and ethmoid sinuses, the left optic nerve sheath, and the bilateral optic chiasm, as well as the right superior orbital fissure. A repeat biopsy confirmed Ewing sarcoma with NKX2.2 and CD99 positivity.

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Results

Emergency chemotherapy was initiated to preserve vision in the right eye. However, within 3 days, vision loss developed in the right eye, with bilateral absence of light perception and optic atrophy. Post-chemotherapy imaging showed regression of chiasmal compression; however, surgery was not pursued due to tumor location and high morbidity risk.

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Conclusion

Sinonasal Ewing sarcoma is a rare and aggressive malignancy that may mimic upper respiratory infections, leading to delayed diagnosis and increased risk of orbital and optic pathway invasion. Rapid progression from unilateral vision loss to bilateral blindness highlights its aggressive nature. Early imaging, accurate diagnosis, and multidisciplinary management are critical for preserving vision.

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Additional Authors

First name	Last name	Base Hospital / Institution
Sena Ozgun	Karaoglan	Istanbul University School Of Medicine
Mehmet Serhat	Mangan	Istanbul University School Of Medicine
Gulsah	Tanyildiz	Istanbul University School Of Medicine
Yasemin	Ozluk	Istanbul University School of Medicine
Zeynep	Canturk	Istanbul University School of Medicine

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