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Impressum
Intra- and extraorbital myositis as initial manifestation of polymyositis
1Höft U., 1Holland D., 2Höft S., 2Maune S., 1Nölle B.
1Department of Ophthalmology, UK Kiel, Hegewischstr. 2, 24105 Kiel, 2Department of Otorhinolaryngology, Head and Neck Surgery, UK Kiel, Arnold-Heller-Str. 2, Germany
Background: With the occurrence of an acute exophthalmos, differential
diagnoses of an orbital tumor, inflammatory process or vascular process
have to be kept in mind. In this case report we demonstrate an intra-
and extraorbital myositis as presenting symptom of polymyositis.
Case report: Five months before being admitted to our department
a 44- year-old patient suffered from an acute exophthalmos with diplopia
on his left eye. A myositic pseudotumor was suspected and a steroidtherapy
as well as a radiotherapy of the orbit were performed. Initially the complaints
improved but after decreasing steroidtherapy the exophthalmos recurred
immediately. Admitting the patient we observed a leftsided exophthalmos
with a complete restriction of the motility and also suspected a compression
of the optic nerve because of a loss of visual acuity and a loss of visiual
field. Additionally, there was a massive swelling of the left temple.
In the MRI we saw a clear thickness of the four rectus muscles and also
a thickening of the temporal muscle. To validate our diagnosis a biopsy
of the musculus temporalis was performed. Histopathologic examination
of the biopsy did show an initial polymyositis. With systemic application
of azathioprin and steroids exophthalmos and pachysomia were decreasing
fastly while visual acuity was improving.
Conclusion: Orbital myositis with exophthalmos can be the first
symptom of a polymyositis. Before starting therapy a biopsy to validate
the diagnosis can be of use.