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Baca V, Barragán-García AA, García-Vega D, Vázquez-Lara Y, Siordia-Reyes G, Yañez-Gutierrez L. Limited granulomatosis with polyangiitis in children with idiopathic orbital inflammation: a case series and literature review. Rheumatol Int 2024; 44:2679-2690. [PMID: 37322355 DOI: 10.1007/s00296-023-05366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
Idiopathic orbital inflammation (IOI) is a diagnosis of exclusion, but the exclusion of other inflammatory diseases of the orbit is broad and relies on clinician experience, response to corticosteroid, or biopsy. This study aimed to investigate the presence of granulomatosis with polyangiitis (GPA) in patients initially diagnosed as IOI and describe its clinicopathological features, ANCA status, treatment, and outcome. We performed a retrospective case series study of children diagnosed with limited GPA (L-GPA) in patients with IOI. A systematic review of the literature was performed in children with GPA and orbital mass. Eleven of 13 (85%) patients with IOI had L-GPA. Two additional patients with orbital mass and L-GPA were included in this analysis. The median age was 10 years, and 75% were female. Twelve cases were ANCA positive and 77% were MPO-pANCA positive. Most patients had a poor response to treatment and had a high relapse rate. Based on literature review, 28 cases were found. Most (78.6%) were female with a median age of 9 years. Three patients were misdiagnosed as IOI. Patients with L-GPA more frequently had MPO-pANCA positivity (35%) than children with systemic GPA (18%) and were less often PR3-cANCA positive than patients with systemic GPA (18% vs. 46%). L-GPA accounts for a high prevalence of children diagnosed as IOI. The high prevalence of MPO-pANCA observed in our study may be related to L-GPA rather than with the orbital mass. Long-term follow-up, orbital biopsy, and serial ANCA testing are necessary to exclude GPA in patients with IOI.
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Affiliation(s)
- Vicente Baca
- Department of Rheumatology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc # 330, Col. Doctores, CP 06720, Mexico City, Mexico.
| | - Alejandro A Barragán-García
- Department of Rheumatology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc # 330, Col. Doctores, CP 06720, Mexico City, Mexico
- Department of Pediatrics, Hospital Gabriel Mancera IMSS, Mexico City, Mexico
| | - Daphne García-Vega
- Department of Ophthalmology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Yolanda Vázquez-Lara
- Department of Ophthalmology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Georgina Siordia-Reyes
- Department of Pathology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Lucelli Yañez-Gutierrez
- Department of Congenital Heart Diseases, Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
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Wu KY, Kulbay M, Daigle P, Nguyen BH, Tran SD. Nonspecific Orbital Inflammation (NSOI): Unraveling the Molecular Pathogenesis, Diagnostic Modalities, and Therapeutic Interventions. Int J Mol Sci 2024; 25:1553. [PMID: 38338832 PMCID: PMC10855920 DOI: 10.3390/ijms25031553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Nonspecific orbital inflammation (NSOI), colloquially known as orbital pseudotumor, sometimes presents a diagnostic and therapeutic challenge in ophthalmology. This review aims to dissect NSOI through a molecular lens, offering a comprehensive overview of its pathogenesis, clinical presentation, diagnostic methods, and management strategies. The article delves into the underpinnings of NSOI, examining immunological and environmental factors alongside intricate molecular mechanisms involving signaling pathways, cytokines, and mediators. Special emphasis is placed on emerging molecular discoveries and approaches, highlighting the significance of understanding molecular mechanisms in NSOI for the development of novel diagnostic and therapeutic tools. Various diagnostic modalities are scrutinized for their utility and limitations. Therapeutic interventions encompass medical treatments with corticosteroids and immunomodulatory agents, all discussed in light of current molecular understanding. More importantly, this review offers a novel molecular perspective on NSOI, dissecting its pathogenesis and management with an emphasis on the latest molecular discoveries. It introduces an integrated approach combining advanced molecular diagnostics with current clinical assessments and explores emerging targeted therapies. By synthesizing these facets, the review aims to inform clinicians and researchers alike, paving the way for molecularly informed, precision-based strategies for managing NSOI.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Merve Kulbay
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC H4A 0A4, Canada
| | - Patrick Daigle
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Bich H. Nguyen
- CHU Sainte Justine Hospital, Montreal, QC H3T 1C5, Canada
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Joseph AK, Guerin JB, Eckel LJ, Dalvin LA, Keating GF, Liebo GB, Benson JC, Brinjikji W, Laack NN, Silvera VM. Imaging Findings of Pediatric Orbital Masses and Tumor Mimics. Radiographics 2022; 42:880-897. [PMID: 35245105 DOI: 10.1148/rg.210116] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.
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Affiliation(s)
- Annie K Joseph
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Julie B Guerin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J Eckel
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lauren A Dalvin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gesina F Keating
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Greta B Liebo
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John C Benson
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Waleed Brinjikji
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Nadia N Laack
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - V Michelle Silvera
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Brown S, Melachuri S, Chundury RV, Reyes-Múgica M, Narayanan S, Fu R. The clinical presentation and magnetic resonance imaging characteristics of an infant with idiopathic orbital inflammation. J AAPOS 2022; 26:98-101. [PMID: 35151874 DOI: 10.1016/j.jaapos.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
Abstract
Idiopathic orbital inflammation is rare in the pediatric population, particularly infants. It can be mistaken either for orbital infection or malignant tumors. We report the case of a 9-month-old previously healthy white boy who presented with right upper eyelid swelling. Magnetic resonance imaging revealed an abnormal T2-hypointense enhancing lesion within the extraconal superior right orbit.
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Affiliation(s)
- Susannah Brown
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rao V Chundury
- Department of Ophthalmology, University of Nebraska, Omaha
| | - Miguel Reyes-Múgica
- Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Srikala Narayanan
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Syndrome d’inflammation orbitaire idiopathique (SIOI) avec myosite de l’enfant : à propos d’un cas. Ann Pathol 2022; 42:189-191. [DOI: 10.1016/j.annpat.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
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6
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Orbital inflammatory disease in a child caused by a ruptured dermoid cyst misdiagnosed as orbital cellulitis. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1013321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aryasit O, Tiraset N, Preechawai P, Kayasut K, Sanghan N, Sittivarakul W. IgG4-related disease in patients with idiopathic orbital inflammation. BMC Ophthalmol 2021; 21:356. [PMID: 34625052 PMCID: PMC8499436 DOI: 10.1186/s12886-021-02115-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023] Open
Abstract
Background To identify the prevalence of positive IgG4 immunostaining in orbital tissue among patients previously diagnosed with nongranulomatous idiopathic orbital inflammation (IOI) and to compare the clinical characteristics of patients with and without IgG4-positive cells. Methods A retrospective review of all patients with a histopathologic diagnosis of IOI was performed. Immunohistochemical staining was performed to identify IgG-positive cells and IgG4-positive cells. Multivariate analysis was performed using likelihood ratio-test logistic regression on the differences between IgG4-related disease (IgG4-RD) and non-IgG4-RD. Results Of the 45 patients included, 21 patients (46.7%) had IgG4-positive cells, with 52.4% being male and a mean age of 55.9 ± 13.4 years. Bilateral ocular adnexal involvement (adjusted odds ratio [aOR] = 9.45; P = 0.016) and infraorbital nerve enlargement (aOR = 12.11; P = 0.008) were frequently found in IgG4-RD patients. Complete remission occurred in 23.8% of IgG4-RD patients and 41.7% of non-IgG4-RD patients. IgG4-RD patients had more frequent recurrent disease than non-IgG4-RD patients. Conclusions Nearly 50% of IgG4-RD patients were previously diagnosed with biopsy-proven IOI. IgG4-RD was more frequent in patients with bilateral disease and infraorbital nerve enlargement, showing the importance of tissue biopsy in these patients. Immunohistochemistry studies of all histopathology slides showing nongranulomatous IOI are highly recommended to evaluate for IgG4-RD.
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Affiliation(s)
- Orapan Aryasit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Nanida Tiraset
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Passorn Preechawai
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Kanita Kayasut
- Anatomical Pathology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Nuttha Sanghan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Wantanee Sittivarakul
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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8
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Kim YJ, Yoo IH. Orbital Myositis Mimicking Status Migrainosus. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2021.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Powell MS, Cross AW, Tallo J, Cheeseman EW, Gilbert MR. Sarcoidosis presenting as bilateral lacrimal gland swelling: a pediatric case report. Pediatr Rheumatol Online J 2021; 19:117. [PMID: 34362395 PMCID: PMC8348864 DOI: 10.1186/s12969-021-00606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To describe a case of pediatric sarcoidosis which initially presented as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without other known systemic involvement. CASE PRESENTATION A 10-year-old female presented to the pediatric ophthalmology clinic with complaints of bilateral eyelid swelling, tearing and itching for approximately 1 month. Her history and exam were most consistent with allergic conjunctivitis, for which she was started on a standard topical regimen. Despite initial improvement, she re-presented with significantly worsened eyelid swelling and minimal allergic symptoms. Enlargement of the lacrimal glands were palpable at this time. Lacrimal gland biopsy was obtained which demonstrated noncaseating granulomas. Systemic workup did not reveal evidence of disease involvement elsewhere. CONCLUSIONS Sarcoidosis in the pediatric population may present in a myriad of ways and is well-known to mimic other disease entities. We present a case of pediatric sarcoidosis which presented initially as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without systemic involvement.
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Affiliation(s)
- Margaret S. Powell
- grid.28803.310000 0001 0701 8607Department of Ophthalmology & Visual Sciences, University of Wisconsin, Madison, WI USA
| | - Ashley W. Cross
- grid.259828.c0000 0001 2189 3475Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Jared Tallo
- grid.259828.c0000 0001 2189 3475College of Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Edward W. Cheeseman
- grid.259828.c0000 0001 2189 3475Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC USA
| | - Mileka R. Gilbert
- grid.259828.c0000 0001 2189 3475Division of Pediatric Rheumatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC USA
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Adult Versus Pediatric Relapse and Recurrence in Orbital Inflammatory Syndrome. Ophthalmic Plast Reconstr Surg 2021; 37:77-80. [PMID: 32427728 DOI: 10.1097/iop.0000000000001705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Orbital inflammatory syndrome (OIS) is a diagnosis of exclusion that has a variable presentation and unpredictable course. Many studies report incomplete or lack of OIS resolution with high recurrence and relapse rates. No studies to date have investigated the characteristics of both recurrence and relapse in OIS. We sought to determine this in both pediatric and adult patients. METHODS A retrospective chart review of 56 patients with OIS was performed between 2004 and 2018. Forty-one patients were identified as adults greater than 18 years of age and 15 were identified as pediatric patients less than 18 years of age. RESULTS Among 56 (41 adult and 15 pediatric) cases of OIS, 18 cases of recurrent disease (32.1%) were identified and 15 (26.8%) patients experienced relapses. All 6 (100%) pediatric patients that had recurrent disease initially suffered from relapses. In contrast, only 1 of the 12 (8.3%) recurrent adult cases initially experienced relapse. Of the 18 patients with recurrent disease, 9 (50%) had multiple recurrences. Underlying etiologies were confirmed in 5 of 18 recurrent cases (27.8%) and 5 of 38 (13.2%) non-recurrent cases. Of the 5 patients with recurrent OIS and an identified etiology, all 5 (100%) demonstrated multiple recurrences. CONCLUSIONS In pediatric cases, relapse was more common and prior episodes of relapse were predictive of later recurrence. Recurrence was relatively common in both groups with half of the patients having multiple recurrences. Identifiable underlying etiologies were more common in patients with recurrent OIS and those cases all demonstrated multiple recurrences.
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Chen F, Tang J, Zhou Q. Bilateral idiopathic orbital pseudotumour in a child: a case report. BMC Ophthalmol 2020; 20:449. [PMID: 33198680 PMCID: PMC7670728 DOI: 10.1186/s12886-020-01718-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Idiopathic orbital pseudotumour is rare in children. We report a case of bilateral paediatric idiopathic orbital pseudotumour and review the characteristics of this case. CASE PRESENTATION A 14-year-old female patient presented at our Department of Pulmonary and Critical Care Medicine (PCCM) with complaints of recurrent severe cold and cough for 3 weeks, which had been treated with an intravenous antibiotic. Meanwhile, the patient developed swelling of both eyelids during the period of cold and cough, but her symptoms did not improve after the ocular administration of tobramycin dexamethasone eye drops. The patient was referred from the respiratory medicine ward to our department because of gradually worsening ocular pain, visual deterioration, increased intraocular pressure and serious nausea/vomiting within 24 h of hospitalization. The diagnosis of bilateral idiopathic orbital pseudotumour was made ultimately because of the course of the disease, exclusion of diagnoses such as bacterial ocular infection or malignant tumours and subsequent evidence from orbital magnetic resonance imaging (MRI). Favourable progress in the ocular tension and eyelid swelling was achieved through treatment with intravenous dexamethasone. The binocular intraocular pressure gradually declined to approximately 15 mmHg, and there was favourable progression in the patient's vision to 20/40 in both eyes on the ninth day of hospitalization. CONCLUSIONS Our patient developed rapidly progressive acute orbital signs and symptoms and anterior inflammation, such as pain, proptosis, limited ductions, periorbital oedema, chemosis, vision loss and high intraocular pressure. This case highlights that idiopathic orbital pseudotumour is an uncommon but important cause of acute orbital syndrome in children.
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Affiliation(s)
- Fangyuan Chen
- The Department of Ophthalmology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue, Tianhe District of Guangzhou, Guangzhou, Guangdong Province, China
| | - Junjie Tang
- The Department of Ophthalmology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue, Tianhe District of Guangzhou, Guangzhou, Guangdong Province, China
| | - Qing Zhou
- The Department of Ophthalmology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue, Tianhe District of Guangzhou, Guangzhou, Guangdong Province, China.
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12
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Sim B, Chng CL, Audrey C, Seah LL. A retrospective study of pediatric thyroid eye disease: the Asian experience. Orbit 2020; 41:69-78. [PMID: 33059514 DOI: 10.1080/01676830.2020.1831550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To study the clinical presentation, disease characteristics, and management approach for children with thyroid eye disease (TED) over a 10 year period in a multidisciplinary Paediatric Thyroid Eye Disease Clinic at a tertiary care referral center. METHODS Retrospective case series of patients with TED at Kandang Kerbau Women's and Children's Hospital (KKWCH) Singapore between August 2006 to June 2015. The diagnosis of TED was clinical based on the Bartley criteria. Ophthalmic examination findings, systemic thyroid function and ophthalmological intervention were recorded. RESULTS Nineteen subjects with pediatric TED were studied. The median age at diagnosis was 12.5 years (range 6-17). The onset of TED was at the same time as their thyroid disease in half of these patients (52.6%) of which all were hyperthyroid except one. The most common signs at TED diagnosis were proptosis (84.2%), lid retraction (63.2%), acquired epiblepharon (63.2%). All patients were inactive and none had evidence of compressive optic neuropathy. TED remained stable in all patients except for one who developed worsening proptosis with exposure keratopathy. No patients were prescribed steroids (oral or intravenous) or had orbital decompression surgery. The most debilitating morbidity was acquired epiblepharon of which out of 12 patients, one had everting sutures and three were offered surgical correction. CONCLUSIONS Paediatric TED subjects exhibit milder clinical manifestations compared to adults. Acquired epiblepharon causes most significant visual morbidity by compromising the corneal surface. Being cognizant of the subtleties of pediatric TED will permit the discerning clinician to effectively manage such cases accordingly.
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Affiliation(s)
- Bryan Sim
- Singapore National Eye Centre, Singapore, Singapore
| | - Chiaw Ling Chng
- Singapore National Eye Centre, Singapore, Singapore.,Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Chia Audrey
- Singapore National Eye Centre, Singapore, Singapore.,Kandang Kerbau Women's and Children's Hospital (KKWCH), Division of Ophthalmology, Singapore, Singapore
| | - Lay Leng Seah
- Singapore National Eye Centre, Singapore, Singapore.,Kandang Kerbau Women's and Children's Hospital (KKWCH), Division of Ophthalmology, Singapore, Singapore
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14
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Abstract
A 14-year-old female with juvenile idiopathic arthritis presented with left-sided recurrent painful periorbital swelling of 5 months duration. MRI revealed enlargement of the left lacrimal gland with extensive inflammatory change involving the orbital and periorbital soft tissues. Lacrimal gland biopsy showed evidence of chronic inflammation, and she had intralesional steroid injection at the time of biopsy. She remained asymptomatic at 6-month follow-up visit. Although juvenile idiopathic arthritis is usually related to intraocular inflammation, it may rarely be associated with dacryoadenitis.
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15
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Eshraghi B, Sonbolestan SA, Abtahi MA, Mirmohammadsadeghi A. Clinical characteristics, histopathology, and treatment outcomes in adult and pediatric patients with nonspecific orbital inflammation. J Curr Ophthalmol 2019; 31:327-334. [PMID: 31528770 PMCID: PMC6742620 DOI: 10.1016/j.joco.2019.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 11/03/2022] Open
Abstract
Purpose To evaluate the clinical characteristics, histopathology, and treatment outcomes in adult and pediatric patients with nonspecific orbital inflammation (NSOI). Methods This retrospective study evaluates 76 patients with NSOI. The patients were categorized in 9 groups according to the site of involvement and histopathology results. These groups included: anterior involvement, dacryoadenitis, myositis, perineural involvement, acute fat involvement, focal mass, orbital apex involvement, diffuse sclerosing form, and multiple tissue involvement. The course of the disease was categorized as acute, subacute, or chronic. The cases with symptom duration of less than 1 week were classified as acute, 1 week to 1 month as subacute, and more than 1 month as chronic. Results 36 (47.4%) patients were males. The mean age was 41.68 ± 17.62 (6-75) years. The most common signs and symptoms were periorbital pain, periorbital edema, decreased ocular movements or diplopia, and conjunctival injection. The most common group was dacryoadenitis in 29 (38.1%) cases. The most common form of disease was the acute involvement (50% of patients). Most of the patients were treated by oral corticosteroids. Duration of follow-up was 7.17 ± 6.26 months. Recurrence occurred in 9 (11.8%) of patients during the follow-up period. Conclusions This study presents a new categorization in which multiple tissue involvements were separated. Some of the NSOI features differ between adults and children. In most patients, treatment especially with corticosteroids, resolves the clinical findings.
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Affiliation(s)
- Bahram Eshraghi
- Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Yeşiltaş YS, Gündüz AK. Idiopathic Orbital Inflammation: Review of Literature and New Advances. Middle East Afr J Ophthalmol 2018; 25:71-80. [PMID: 30122852 PMCID: PMC6071347 DOI: 10.4103/meajo.meajo_44_18] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Idiopathic orbital inflammation (IOI) is a benign inflammatory condition usually confined to the orbit but extraorbital extension can also occur. IOI has been classified into categories including anterior, diffuse, posterior or apical, myositis, and dacryoadenitis. Other rare types of IOI include periscleritis, perineuritis, and focal mass. Diagnosis is based on careful history, clinical findings, computed tomography, and magnetic resonance imaging findings. An orbital biopsy is usually done for accessible orbital lesions such as dacryoadenitis. For other types such as myositis and apical IOI where surgery is difficult or dangerous, orbital biopsy is not initially considered. The mainstay of therapy consists of systemic corticosteroids, but other options including external beam radiotherapy, antimetabolites, alkylating agents, T-cell/calcineurin inhibitors, lymphocyte inhibitors, tumor necrosis factor-α inhibitors, and surgical debulking have also been used.
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Affiliation(s)
- Yağmur Seda Yeşiltaş
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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17
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LaPonsie SA, Rabiah PK. When an Orbital Infection Isn't Infectious at All: A Review of Orbital Inflammatory Syndrome. Pediatr Ann 2017; 46:e433-e436. [PMID: 29131924 DOI: 10.3928/19382359-20171023-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Orbital inflammatory syndrome (OIS) includes a wide range of clinical manifestations and may initially be misdiagnosed as orbital cellulitis due similar symptoms of fever, periorbital swelling, and pain with eye movements. A diagnosis of OIS requires evaluation for underlying systemic disorders including autoimmune disorders and thyroid disease. Symptoms typically improve rapidly after initiation of steroid therapy, although recurrence can occur. This article presents an illustrative case of a 13-year-old girl with OIS. [Pediatr Ann. 2017;46(11):e433-e436.].
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Briones MR, Morgan GA, Amoruso MC, Rahmani B, Ryan ME, Pachman LM. Decreased CD3-CD16+CD56+ natural killer cell counts in children with orbital myositis: a clue to disease activity. RMD Open 2017; 3:e000385. [PMID: 28955482 PMCID: PMC5604601 DOI: 10.1136/rmdopen-2016-000385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/30/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
The study aimed to document the utility of the absolute number of natural killer cells as a biomarker in paediatric orbital myositis (OM). Extracted data from four children with OM included demographics, laboratory values, imaging and treatment response. Stored sera (−80°C) were tested for IgG4 levels in three cases and antibody to Coxsackie B in two cases. Their first symptom was at 14.4±1.2 years (mean±SD). At diagnosis three had creatine phosphokinase (CPK) of 97.3±44.2, aldolase of 8.5±2.8 (n=2), alanine aminotransferase (ALT) of 13±2.8 (n=2) and aspartate aminotransferase (AST) of 21.3±2.9. IG4 level was 87.7±66 (normal=8–89 mg/dL); two sera (patients 1and4) were positive (>1:8 dilution) for anti-Coxsackievirus antigen B5. The CD3-CD16+CD56+ natural killer absolute count was 96.7±28.7 (lower limit of normal=138), increasing to 163±57.2 with disease resolution in three patients. The fourth patient was followed elsewhere. CT showed involvement of bilateral superior oblique, lateral rectus or the left medial rectus muscles. Treatment included intravenous methylprednisolone, methotrexate (n=2) and other immunosuppressants. Paediatric OM disease activity was associated with initially low absolute CD3-CD16+CD56+ natural killer cell counts, which normalised with improvement. We speculate (1) infection, such as Coxsackie B virus, may be associated with paediatric OM; and (2) the absolute count of circulating CD3-CD16+CD56+ natural killer lymphocytes may serve as a biomarker to guide medical therapy.
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Affiliation(s)
- Melissa R Briones
- Division of Allergy, Immunology, and Rheumatology, Loyola University Medical Center, Maywood, USA
| | - Gabrielle A Morgan
- Pediatrics, Stanly Manne Children's Research Institute, Children's Hospital of Chicago; Ann and Robert H. Lurie Children's Hospital, Chicago, USA
| | - Maria C Amoruso
- Pediatrics, Stanly Manne Children's Research Institute, Children's Hospital of Chicago; Ann and Robert H. Lurie Children's Hospital, Chicago, USA
| | - Bahram Rahmani
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Maura E Ryan
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA
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19
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Pediatric Idiopathic Orbital Inflammation: Clinical Features of 30 Cases. Ophthalmic Plast Reconstr Surg 2016; 32:270-4. [DOI: 10.1097/iop.0000000000000494] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Patel A, Modjtahedi BS, Freitag SK, Sobrin L, Kazlas MA. Idiopathic Orbital Inflammation Presenting with Bilateral Panuveitis. J Pediatr Ophthalmol Strabismus 2016; 53 Online:e18-21. [PMID: 27112170 DOI: 10.3928/01913913-20160406-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/27/2016] [Indexed: 11/20/2022]
Abstract
Idiopathic orbital inflammation or orbital pseudotumor is rare in the pediatric population and may present with ocular findings not normally seen in the adult population. The authors report the case of a 14-year-old boy with idiopathic orbital inflammation who presented with bilateral panuveitis to highlight the features that make this diagnosis more difficult in the pediatric population.
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21
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Abstract
Strabismus may result from abnormal innervation, structure, or function of the extraocular muscles. Abnormalities of the orbital bones or masses within the orbit may also cause strabismus due to indirect effects on the extraocular muscles. This paper reviews some disorders of the orbit that are associated with strabismus, including craniofacial malformations, orbital masses, trauma, and anomalous orbital structures.
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Affiliation(s)
- Gregg T Lueder
- Departments of Ophthalmology and Visual Sciences and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
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22
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Oguz B, Ozcan HN, Omay B, Ozgen B, Haliloglu M. Imaging of childhood inflammatory myofibroblastic tumor. Pediatr Radiol 2015; 45:1672-81. [PMID: 26135643 DOI: 10.1007/s00247-015-3377-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 03/06/2015] [Accepted: 04/22/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumor is a rare benign neoplasm and most commonly involves the lung but occurs in extrapulmonary locations. OBJECTIVE To present imaging findings in inflammatory myofibroblastic tumors in children based on a single-centre experience. MATERIALS AND METHODS We retrospectively reviewed CT and MRI findings of children diagnosed with inflammatory myofibroblastic tumor in a single institution. RESULTS We identified 15 children (range: 1-17 years) with inflammatory myofibroblastic tumor. The tumor was localized to the lung (n = 5), mediastinum (n = 3), trachea (n = 1), bronchus (n = 1), abdomen (n = 2) and orbit (n = 3). All the extraorbital tumors were solid masses with homogeneous or heterogeneous enhancement. Four lung tumors and one posterior mediastinal tumor contained calcification. Local recurrence following surgical removal occurred in two children with invasion of the esophagus and of the left atrium in one. Localized masses were seen in all children with orbital tumour. Two of these had episcleritis and perineuritis; one had episcleritis, tendonitis, perineuritis, myositis and dacryoadenitis. CONCLUSION The locations and imaging features of inflammatory myofibroblastic tumors are variable.
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Affiliation(s)
- Berna Oguz
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey.
| | - Hatice Nursun Ozcan
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
| | - Burak Omay
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
| | - Burce Ozgen
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
| | - Mithat Haliloglu
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
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Abstract
Dacryoadenitis, a condition defined as inflammation of the lacrimal gland, has many etiologies; rarely is it associated with a lacrimal gland abscess. In this article, a 7-year-old African American boy was diagnosed with a lacrimal gland abscess secondary to oxacillin-resistant Staphylococcus aureus (ORSA). The incidence of conditions arising from ORSA, a term used interchangeably with methicillin-resistant S aureus (MRSA), is reportedly on the rise in our population over the past decade. Recognition of atypical pathogens, initiation of timely appropriate-spectrum pharmaceuticals, and conservative follow-up are imperative in treating and preventing potentially vision-threatening sequelae of dacryoadenitis.
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Affiliation(s)
- Amar Sayani
- Rochester Ophthalmological Group, Rochester, NY, USA
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24
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Yazicioglu T, Kutluturk I. Idiopathic Orbital Myositis in a 9-Year-Old Girl: A Case Report. IRANIAN JOURNAL OF PEDIATRICS 2015. [PMID: 26199706 PMCID: PMC4505988 DOI: 10.5812/ijp.25(3)2015.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Titap Yazicioglu
- Istanbul Kartal Dr. Lutfi Kirdar Training and Research Hospital, Eye Clinic, Istanbul, Turkey
| | - Isil Kutluturk
- Istanbul Kartal Dr. Lutfi Kirdar Training and Research Hospital, Eye Clinic, Istanbul, Turkey
- Corresponding author: Isil Kutluturk, Istanbul Kartal Dr. Lutfi Kirdar Training and Research Hospital, Eye Clinic, Istanbul, Turkey. Tel: +90-5058611984, Fax: +90-2625266664, E-mail:
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25
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Mittal R, Ganguly A, Rath S, Das B, Mishra A. IgG4-related orbital inflammation presenting as bilateral proptosis in a child. Eye (Lond) 2014; 28:1264-6. [PMID: 24993327 DOI: 10.1038/eye.2014.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- R Mittal
- Dalmia Ophthalmic Pathology Service, L V Prasad Eye Institute, Bhubaneswar, India
| | - A Ganguly
- Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, L V Prasad Eye Institute, Bhubaneswar, India
| | - S Rath
- Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, L V Prasad Eye Institute, Bhubaneswar, India
| | - B Das
- Department of Medicine, SCB Medical College and Hospital, Cuttack, India
| | - A Mishra
- Clinical Services, Radharaman Hospital, Cuttack, India
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26
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Kim SM, Yoon JS. A Case of Epstein-Barr Virus-Related Dacryoadenitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.9.1372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Myung Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sook Yoon
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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27
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Kalapesi FB, Garrott HM, Moldovan C, Williams M, Ramanan A, Herbert HM. IgG4 orbital inflammation in a 5-year-old child presenting as an orbital mass. Orbit 2013; 32:137-140. [PMID: 23480695 DOI: 10.3109/01676830.2013.764449] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
IgG4 is a newly known systemic disorder. It can present as orbital inflammation or as an orbital mass. We describe the case of a 5-year-old child with proptosis and globe dystopia who went on to have an orbital biopsy. Initially this was reported to be idiopathic orbital inflammation. After IgG4-RD was considered in the differential, the orbital biopsy was revisited, immunohistochemistry was done and the patient's serum was tested for IgG subclass levels. IgG4-RD was diagnosed and the patient was subsequently treated with prednisone and mycophenolate and made a good recovery. This is the youngest reported case of IgG4-RD in a child.
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Affiliation(s)
- Freny Boman Kalapesi
- Oculoplastics and Orbital Department, Bristol Eye Hospital, Bristol, United Kingdom.
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28
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Derr C, Shah A. Bilateral dacryoadenitis. J Emerg Trauma Shock 2012; 5:92-4. [PMID: 22416166 PMCID: PMC3299166 DOI: 10.4103/0974-2700.93096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 05/11/2011] [Indexed: 12/13/2022] Open
Abstract
Acute dacryoadenitis is an uncommon condition that involves inflammation of the lacrimal gland. In rare instances, dacryoadenitis may be bilateral. A delay in proper treatment of an otherwise simple case of dacryoadenitis may lead to significant soft tissue morbidity such as cellulitis, lacrimal gland abscess, or orbital abscess. We report the case of a 24-year-old male who presented to the emergency department with acute bilateral dacryoadenitis. The patient's symptoms did not respond to oral antibiotics and he subsequently required admission for intravenous antibiotics. During his hospitalization the patient had diagnostic testing to try to determine the etiology for his symptoms. The unique aspects of managing a case of bilateral dacryoadenitis as well as treatment recommendations are discussed in this case report.
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Affiliation(s)
- Charlotte Derr
- University of South Florida, Emergency Medicine Residency Program, Tampa-FL, USA
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29
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Guedj R, Desguerre I, Brassier A, Boddaert N, Hubert P, Oualha M. Unusual muscular injury in an infant with severe H1N1 infection. Pediatr Neurol 2012; 47:51-4. [PMID: 22704018 DOI: 10.1016/j.pediatrneurol.2012.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/04/2012] [Indexed: 11/16/2022]
Abstract
We report the first well-documented case of unilateral orbital myositis in an 8-month-old boy with life-threatening pandemic H1N1 infection. He presented with status epilepticus and hemodynamic failure associated with unusual right orbital myositis and acute rhabdomyolysis. Because of severe myolysis, metabolic screening was performed to exclude metabolic and genetic etiologies. After corticosteroid administration and symptomatic support, the disease evolution was favorable, without sequelae at hospital discharge. H1N1 influenza infection may be associated with multiple organ failure, and complicated by unusual muscle injury. The presence of intense myolysis should alert practitioners to potential metabolic and genetic etiologies.
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Affiliation(s)
- Romain Guedj
- Service de Réanimation Polyvalente et Néonatale, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, Paris, France
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31
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Boulter EL, Eleftheriou D, Sebire NJ, Edelsten C, Brogan PA. Inflammatory lesions of the orbit: a single paediatric rheumatology centre experience. Rheumatology (Oxford) 2012; 51:1070-5. [DOI: 10.1093/rheumatology/ker432] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Yum HR, Kang NY. Idiopathic Orbital Inflammation Presenting as Unilateral Dacryoadenitis in a Child. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hae-ri Yum
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Nam-Yeo Kang
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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