ABSTRACT
A 66-year-old immunocompetent man with preceding travel through the Northeastern United States developed Guillain-Barré syndrome. A broad search for infections revealed intraerythrocytic parasites on blood smear and positive polymerase chain reaction for Babesia microti; elevated IgM/IgG serologies for Ehrlichia chaffeensis; elevated IgM/IgG serologies and qualitative polymerase chain reaction for Epstein-Barr virus; and fecal culture growth of Arcobacter butzleri. In this report, we discuss the known or suspected association of these infectious agents with Guillain-Barré syndrome. This case also highlights the importance, in the setting of endemic exposure, of screening for multiple coinfections that can be transmitted by the same arthropod vector.
ABSTRACT
Neuroendocrine tumors (NETs) of the orbit are a rare but increasingly recognized clinical phenomenon. The vast majority of orbital NETs are metastatic, and most metastasize from the gastrointestinal system to the extraocular muscles. While orbital metastasis typically occurs in the setting of a known primary neoplasm, some cases represent the initial manifestation of disease and can precede detection of the primary tumor by many months. We report a 58-year-old woman who presented with diplopia, unilateral orbital pain, erythema, and chemosis as the primary presentation of a metastatic small intestine NET. This case serves as a reminder that identification of orbital NETs should prompt investigation for primary gastrointestinal or pulmonary NETs. Goals of surgery include obtaining a tissue sample, debulking the lesion, and preserving visual function.
