ABSTRACT
The occurrence of orbital compartment syndrome is a rare and unusual complication of systemic lupus erythematosus (SLE). Patients will present with symptoms of ocular pain and diplopia and visible signs of proptosis. The condition is considered an ophthalmological emergency because the myositis involving the ocular muscles can cause irrevocable damage to the retina and optic disk, potentially leading to blindness. We report a case of a young African American male who developed orbital myositis with compartment syndrome as his initial manifestation of SLE. The patient underwent an emergent orbital decompression, followed by prompt initiation of immunosuppressant medications. To our knowledge, this is the first report of a case of myositis secondary to SLE complicated by compartment syndrome of the orbit.
Subject(s)
Compartment Syndromes/etiology , Emergency Treatment , Lupus Erythematosus, Systemic/complications , Orbital Myositis/etiology , Compartment Syndromes/diagnostic imaging , Compartment Syndromes/surgery , Decompression, Surgical , Humans , Immunosuppressive Agents , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Male , Orbital Myositis/diagnostic imaging , Orbital Myositis/surgery , Tomography, X-Ray Computed , Young AdultABSTRACT
Idiopathic orbital myositis (IOM) is a subtype of orbital inflammatory disease characterized by primarily involving the extraocular muscle. The signs and symptoms of IOM may also be seen in such processes as orbital cellulitis, primary or metastatic orbital neoplasm, carotid-cavernous fistulae, arteriovenous malformations, cavernous sinus thrombosis, and thyroid eye disease, and because there is no pathognomonic sign, symptoms, laboratory test, or radiologic findings, its diagnosis is often provisional. In our case, diagnosis of IOM was more difficult because our patient presented with proptosis after alloplastic implant insertion in the blow-out fracture. After considering radiologic and physical findings, we concluded that cellulitis was more likely as initial diagnosis. To remove foreign body or pus, surgical exploration was done, but intraoperative findings did not show any pus or sign of infection but diffuse enlargement and swelling of inferior rectus muscle. The diagnosis was confirmed as IOM, and the patient was treated with systemic corticosteroid. Although proptosis after alloplastic insertion in blow-out fracture is usually a sign of cellulitis, this case illustrates that it may also occur in patients with IOM.
