Subject(s)
Chorioretinitis/diagnostic imaging , Eye Infections, Bacterial/diagnostic imaging , Retinal Pigment Epithelium/diagnostic imaging , Syphilis/diagnostic imaging , Tomography, Optical Coherence , Acute Disease , Agglutination Tests , Anti-Bacterial Agents/therapeutic use , Chorioretinitis/drug therapy , Chorioretinitis/microbiology , Drug Therapy, Combination , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Glucocorticoids/therapeutic use , Humans , Immunoglobulin M/blood , Male , Penicillin G/therapeutic use , Prednisone/therapeutic use , Retinal Pigment Epithelium/pathology , Slit Lamp Microscopy , Syphilis/drug therapy , Syphilis/microbiology , Treponema pallidum/immunology , Visual AcuityABSTRACT
Merkel cell carcinoma is a rare neuroendocrine tumor of subspecialized dermal mechanoreceptors, associated with immunosuppression. The usual ophthalmic presentation is an eyelid lesion. The authors present a case of biopsy-proven orbital metastatic Merkel cell carcinoma in the absence of any eyelid lesion, in an immunosuppressed patient with a history of multiple cancers. There are to the authors' knowledge only 2 other case reports of presumed metastatic Merkel cell carcinoma to the orbit, though neither were biopsied. Despite its rarity, metastatic Merkel cell carcinoma should be included in the differential of a metastatic orbital lesion, in the patient with a known or suspected cutaneous primary. The patient has had an excellent response to combined radiotherapy and programmed death-1 inhibitor pembrolizumab, and this case highlights the potential benefit of an exciting new biologic therapy.
