A Case of Orbital Myositis Presenting With Dizziness
BACKGROUND: Orbital myositis is an idiopathic, inflammatory, non-infectious condition, typically confined to more than one extraocular muscle and usually targeting young females in their third decade.
CASE REPORT: We describe a case of orbital myositis uncommonly afflicting an adult male. He initially presented with a sensation of dizziness when turning his head and mobilising, together with right-sided orbital pain that failed to respond to the vestibular sedative cinnarizine. Failure to resolve and development of diplopia initially prompted a working diagnosis of ocular myasthenia gravis. On further investigation using HESS charting, paresis in the inferior and medial rectus and superior oblique ocular muscles of the right eye were elicited correlating with clinical examination. However, the lack of response to low dose steroids and acetylcholinesterase inhibitors, together with a negative screen for myasthenia antibodies, precluded a diagnosis of ocular myaesthenia gravis from being made. Other investigations included a high creatinine kinase and lactate dehydrogenase which indicated pathology in the extraocular muscles themselves. An MRI scan showed normal extraocular muscle thickness while excluding other orbital pathology. Exclusion of a variety of other conditions subsequently led to a diagnosis of orbital myositis.CONCLUSION: Response to high dose steroids consolidated this diagnosis with a rapid response ascertained clinically by resolution of pseudo-vertigo and pain, as well as the ophthalmoplegia with follow-up on HESS charting. We aim to raise awareness of this rare condition that carries a good response to steroids.
Plum Analytics Artifact Widget Block
Kralik SF, Kersten R, Glastonbury CM. Evaluation of orbital disorders and cranial nerve innervation of the extraocular muscles. Magn Reson Imaging Clin N Am. 2012; 20:413â€“434. https://doi.org/10.1016/j.mric.2012.05.005 PMid:22877949
Costa RM, Dumitrascu OM, Gordon LK. Orbital myositis: diagnosis and management. Curr Allergy Asthma Rep. 2009; 9:316â€“323. https://doi.org/10.1007/s11882-009-0045-y PMid:19656480
Inaba H, Hayakawa T, Miyamoto W, Takeshima K, Yamaoka H, Furukawa Y, Kawashima H, Ariyasu H, Wakasaki H, Furuta H, et al. IgG4- related ocular adnexal disease mimicking thyroid-associated orbitopathy. Intern Med. 2013; 52:2545â€“2551. https://doi.org/10.2169/internalmedicine.52.0902 PMid:24240795
Chapman PR, Gaddamanugu S, Bag AK, Roth NT, Vattoth S. Vascular lesions of the central skull base region. Semin Ultrasound CT MR. 2013; 34:459â€“475. https://doi.org/10.1053/j.sult.2013.09.003 PMid:24216454
Danesh-Meyer HV, Rosser PM. Orbital inflammatory disease. Int Ophthalmol Clin. 2007; 47:79â€“92. https://doi.org/10.1097/IIO.0b013e3181571eee PMid:18049282
Yan J, Wu P. Idiopathic orbital myositis. J Craniofac Surg. 2014; 25(3):884-7. https://doi.org/10.1097/SCS.0000000000000510 PMid:24670274
Schoser BG. Ocular myositis: diagnostic assessment, differential diagnoses, and therapy of a rare muscle disease - five new cases and review. Clin Ophthalmol. 2007; 1(1):37-42. PMid:19668464 PMCid:PMC2699981
Algorithm flowchart taken from: webeye.ophth.uiowa.edu/.../cases/234-Idiopathic-Orbital-Myositis.htm
Ã–nder Ã–, Bilgin RR, KÃ¶ÅŸkderelioÄŸlu A, GedizlioÄŸlu M. Orbital myositis: evaluating five new cases regarding clinical and radiological features. NÃ¶ro Psikiyatri ArÅŸivi. 2016; 53(2):173. https://doi.org/10.5152/npa.2015.10214 PMid:28360792 PMCid:PMC5353024
All rights reserved.