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Klin Monbl Augenheilkd 2008; 225(5): 510-513
DOI: 10.1055/s-2008-1027313
Kasuistik

© Georg Thieme Verlag KG Stuttgart · New York

Isolated Lateral Rectus Myositis as a Manifestation of Idiopathic Orbital Inflammation[1]

J. M. Katsimpris1 , I. K. Petropoulos2 , A. Kordelou1 , D. Petkou1 , D. Feretis1
  • 1Department of Ophthalmology, General Hospital of Patras ‘O Agios Andreas’, Patras, Greece (Chairman: D. Feretis, MD)
  • 2Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland (Chairman: Prof. A. B. Safran)
Further Information

Publication History

received: 14.9.2007

accepted: 13.11.2007

Publication Date:
05 May 2008 (online)

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Zusammenfassung

Hintergrund: Fallbericht eines Patienten mit isolierter, akuter, monolateraler, monomuskulärer Myositis des M. rectus externus als Manifestation einer lokalisierten, unspezifischen, idiopathischen, orbitalen Entzündung. Anamnese und Befund: Ein 25-jähriger männlicher Patient meldete sich in unserer Klinik wegen eines schmerzhaften rechten Auges und Doppelbildern im Rechtsblick. Klinisch zeigte sich eine umschriebene konjunktivale Hyperämie im Bereich des Muskelansatzes des M. rectus externus und ein leichtgradiger Exophthalmus rechts. In den axialen CT-Bildern fand sich eine spindelförmige Verdickung des rechten M. rectus externus mit ebenfalls verdickter Muskelsehne an ihrem bulbären Ansatz. Mittels weiterer klinischer und laborchemischer Untersuchungen konnte eine andere lokale oder systemische Ursache ausgeschlossen werden. Therapie und Verlauf: Klinisch und mittels bildgebender Verfahren (CT/MRI) wurde die Diagnose einer isolierten, akuten, monolateralen, monomuskulären Myositis des M. rectus externus rechts gestellt. Unter adäquater Therapie mit oralen Steroiden, welche langsam wieder ausgeschlichen werden konnten, kam es zu einer raschen Besserung der subjektiven Beschwerden und vollständigen Remission der Befunde innert Tagen mit komplikationslosem weiterem Verlauf. Schlussfolgerungen: Eine isolierte Myositis des M. rectus externus kann eine Manifestation einer idiopathischen orbitalen Entzündung sein. Die Diagnose ergibt sich aus der Klinik und bildgebenden Befunden (MRI/CT) nach Ausschluss anderer lokaler oder systemischer entzündlicher, endokriner und neoplastischer Ursachen.

Abstract

Background: We report the case of of a patient with isolated, acute, monolateral and monomuscular lateral rectus myositis as a manifestation of a localized, nonspecific, idiopathic orbital inflammation. History and Signs: A 25-year-old man presented to our clinic with a painful right eye and associated double vision on right gaze due to a limitation of abduction. Conjunctival hyperemia was observed in the area of the right lateral muscle insertion. A slight axial proptosis of the right eye was evident. On axial CT scans a fusiform enlargement of the right lateral rectus muscle including a thickened anterior tendon at its insertion was recorded. A thorough systemic and laboratory investigation showed neither any further abnormal findings nor any systemic disease. Therapy and Outcome: A monocular, monomuscular myositis as a clinical manifestation of idiopathic orbital inflammation was diagnosed by the clinical findings and imaging with orbital CT/MRI scans. By appropriate treatment with oral steroids slowly tapered over weeks, symptoms and signs showed full remission without any complications. Clinical improvement was observed within a few days after the beginning of steroid administration. Conclusions: Isolated lateral rectus myositis can be a manifestation of idiopathic orbital inflammation. Diagnosis is made by the clinical presentation and imaging with orbital MRI/CT-scans. Other local or systemic inflammatory, endocrine or neoplastic diseases must be ruled out.

Schlüsselwörter

idiopathische orbitale Entzündung - Pseudotumor orbitae - orbitale Myositis - Musculus rectus externus - Abduktionseinschränkung - Diplopie - Protrusio bulbi - Kortikosteroide

Key words

idiopathic orbital inflammation - orbital pseudotumor - orbital myositis - lateral rectus muscle - limitation of abduction - diplopia - proptosis - corticosteroids

1 Presented at the 100th Annual Congress of the SOG/SSO, Montreux, 5. - 8.9.2007.

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1 Presented at the 100th Annual Congress of the SOG/SSO, Montreux, 5. - 8.9.2007.

John M. Katsimpris, MD, PhD

Ritsou & Empeirikou Street 73

26335 Patras

Greece

Phone: ++ 30/2 61/0 64 34 97, ++ 30/69/36 95 09 50

Fax: ++ 30/2 61/0 64 34 97

Email: jkatsimpris@yahoo.com

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