RESUMO
Orbital pseudotumor is a benign condition that accounts for approximately 10% of all orbital mass lesions. Any part of the orbit may be involved. The etiology is unknown. The presentation may be either acute or subacute. Patients may present with a palpable mass, a swollen eyelid, congestion, pain, diminished ocular motility, and/or decreased visual acuity. Approximately, 25% of patients present with bilateral disease. A modest proportion of patients experience resolution of their symptoms without treatment. Biopsy is indicated for those who do not respond to, or relapse after, first-line therapy. Oral corticosteroids are the initial treatment and approximately 80% of patients respond. Roughly half of those who respond to corticosteroids relapse. Second-line therapy consists of either low-dose radiotherapy (20-30 Gy at 2 Gy per fraction), cytotoxic chemotherapy, or immunosuppressive agents. Radiotherapy results in long-term local control rates of 50% or higher. Limited lesions may be successfully resected. A small subset of patients may experience inexorable progression to a fixed, painful, sightless eye and require orbital exenteration.
Assuntos
Pseudotumor Orbitário , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antineoplásicos/uso terapêutico , Biópsia , Diagnóstico Diferencial , Diagnóstico por Imagem/métodos , Humanos , Imunossupressores/uso terapêutico , Neoplasias Orbitárias/diagnóstico , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/tratamento farmacológico , Pseudotumor Orbitário/patologia , Pseudotumor Orbitário/radioterapia , Pseudotumor Orbitário/cirurgia , Resultado do TratamentoRESUMO
A 52-year-old, immune-suppressed man presented with painful proptosis. Orbital imaging revealed enhancement of his right inferior rectus muscle and mild ethmoidal sinus disease. Sinus washings and turbinectomy demonstrated Curvularia. Despite aggressive intravenous antimicrobials, the patient remained febrile. Repeat imaging demonstrated a well-defined intramuscular abscess without contiguous orbital or paranasal involvement. Following surgical drainage, the patient improved. Cultures of the material expressed from the abscess confirmed a co-infection with Fusarium. Although rare, fungal abscess of the extraocular muscle should be considered in patients (particularly if immunosuppressed) with extraocular muscle enlargement resistant to conventional antimicrobial therapy. Prompt diagnosis and treatment could potentially prevent further serious morbidity or mortality.
Assuntos
Abscesso/microbiologia , Ascomicetos/isolamento & purificação , Infecções Oculares Fúngicas/microbiologia , Fusarium/isolamento & purificação , Micoses/microbiologia , Celulite Orbitária/microbiologia , Doenças dos Seios Paranasais/microbiologia , Abscesso/diagnóstico , Abscesso/terapia , Antifúngicos/uso terapêutico , Terapia Combinada , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/terapia , Músculos Oculomotores/patologia , Celulite Orbitária/diagnóstico , Celulite Orbitária/terapia , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/terapia , Tomografia Computadorizada por Raios XRESUMO
A preterm male infant developed a rapidly growing, treatment-resistant orbital hemangioma. Despite aggressive management, the patient required enucleation of his right eye and image-guided ethanol sclerosis to limit tumor progression intracranially.
