EXOPHTHALMOS REVEALING AN INFLAMMATORY PSEUDOTUMOR : A CASE REPORT

Published 2022 - 26th ESCRS Winter Meeting

Reference: P249 | Type: Abstracts | DOI: 10.82333/rsf4-tn14

Authors: El Hamraoui Kenza* ¹ , Moctar Issiaka ² , Khalil Zrikem ² , Adil Mchachi ² , Laila Benhmidoune ² , Abderrahim Chakib ² , Rayad Rachid ² , Mohamed El Belhadji ²

¹Adult Ophthalmology Department ,20 August Hospital, CHU Ibn Rochd,CASABLANCA,Morocco, ²Adult Ophthalmology Department,20 August Hospital, CHU Ibn Rochd,CASABLANCA,Morocco

Purpose

Idiopathic orbital inflammation syndrome, better known as inflammatory pseudotumor, corresponds to any intra-orbital expansive process of inflammatory type, histologically characterized by non-specific inflammation of the orbit, with no local or systemic cause found. The differential diagnosis is essential with malignant tumor causes dominated in adults by lymphoproliferative syndromes and metastases.

To report a case of inflammatory pseudotumor in a 25-year-old female who responded favorably to corticosteroid treatment.

Setting

A case of inflammatory pseudotumor revealed by exophthalmos in a 25 year old patient seen in our department

Methods

This is a 25-year-old female patient with no previous history of inflammatory pseudotumor who presented with a right unilateral inflammatory exophthalmos of progressive onset for the past 15 days, complicated by ocular pain for the past 24 hours, which prompted the consultation.

Results

The ophthalmological examination showed moderate right ptosis with exophthalmos, non-axial, non-pulsatile, without a thrill, slightly painful, with minimal VAD without diplopia, and limited right abduction. The slit-lamp examination did not reveal any surface damage, and a normal fundus with an ocular tone of 18 mmHg. The patient did not report any hemoptysis or haematuria. The rest of the clinical examination did not reveal any signs of extraocular involvement. An MRI was ordered, revealing a thickened, diffuse, and homogeneous aspect of the external rectus muscle with respect for its tendon, infiltration of the lateral extra conical fat, and the right lacrimal gland, all responsible for a grade 3 exophthalmos. The etiological work-up (systemic granulomatosis, vasculitis, Graves' disease) came back normal. Treatment with oral corticosteroids at a dose of 1mg/kg/day, combined with supplementation, was initiated for 1 month. A spectacular response was observed, allowing the diagnosis of a non-specific pseudotumor to be made. The evolution was favorable without relapse or complication with a 3-month follow-up.

Conclusion

Inflammatory pseudotumors are a diagnosis of exclusion based on a range of anatomical and clinical or morphological arguments, confirmed in some cases by an orbital biopsy. They remain corticosensitive in the majority of cases.