A case of eosinophilic myositis associated with orbital myositis

Idiopathic eosinophilic myositis: a systematic literature review

Eosinophilic myositis belong to the idiopathic inflammatory myopathies and are defined by an inflammatory infiltrate composed of eosinophils within the muscle. To date, no consensus exists for diagnosis and care of such patients. The aim of this review was to describe clinical and histological presentation, treatment, and outcome of eosinophilic myositis based on a systematic review of all published histologically proven cases of eosinophilic myositis. A total of 453 records were identified in MEDLINE until November 2020. A total of 69 published cases were identified. The analysis of these allowed the distinction of the 3 previously described pathological subtypes: focal eosinophilic myositis (n = 17); diffuse eosinophilic myositis (n = 36); and eosinophilic perimyositis (n = 16). We propose a simple algorithm for diagnosis and treatment strategy for the care of patient with muscular symptoms and blood eosinophilia. This work also highlights eosinophilic myositis pathogenesis and the need for careful investigations in order to rule out differential diagnoses.

Focal Eosinophilic Myositis Affecting the Orbicularis Muscle: Clinical and Image Aspects

Focal eosinophilic myositis (FEM) is a rare disease that is even more uncommon in affecting the periocular area. The authors are reporting the first case of FEM occurring in the lower eyelid of a 45-year-old Caucasian female who presented with localized painful area of glossy induration and peau d'orange skin lesion. Magnetic resonance image shows significant hyperintense thickening of the pre-septal orbicularis muscle region on T2-weighted images. Incisional biopsy of the induration revealed marked fibrinoid degeneration of the orbicularis muscle and adjacent fascia, mixed cellular infiltration of lymphocytes and eosinophils and a predominant CD8+ lymphocytic infiltrates in the immunohistochemical study. The final diagnosis was FEM. Oral prednisolone improved symptoms and the lesions disappeared, with no recrudescence in a one year follow-up.

A case of eosinophilic orbital myositis associated with CSS

We report a novel case of eosinophilic orbital myositis associated with Churg-Strauss syndrome. A 56-year-old man with a 20-year history of chronic sinusitis and seasonal allergic rhinitis was admitted because of fever, swelling of cheeks and extremities, diplopia, and eosinophilia. With findings from gadolinium-enhanced FST1WI of the orbits and a muscle biopsy of the skeletal muscle, the diagnosis was made. He was treated with oral corticosteroid, and his symptoms rapidly improved.