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Abad S, Héran F, Terrada C, Bielefeld P, Sène D, Trad S, Saadoun D, Sève P. [Management of orbital inflammation in internal medicine. Proposal for a diagnostic work-up]. Rev Med Interne 2018; 39:746-754. [PMID: 29398045 DOI: 10.1016/j.revmed.2017.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 12/17/2022]
Abstract
Inflammatory orbitopathies relate to an inflammatory state originating within the orbit and its adnexes, except the inner ocular globe. Orbital inflammation (OI) may be either localized manifestation of a proven or like autoimmune disease, or local response from immune system against infectious, structural or tumoral antigens. We review the clinical manifestations of OI, which provide helpful clues to the diagnosis and describe the inflammatory, infectious and neoplastic conditions classically associated with OI. Autoimmune diseases are probably the most common causes of OI associated with a bilateral dacryoadenitis (e.g., sarcoidosis, granulomatosis with polyangiitis, IgG4-related disease). We focused on a major part of the IgG4-RD spectrum, the IgG4-related orbital disease which has been recently described and the idiopathic orbital inflammation syndrome that one should consider in patients 40 years of age or older with non specific inflammation OI on biopsy but without underlying local or systemic disease. An algorithm for the diagnostic approach of OI was proposed. If systemic explorations fail to diagnose an underlying disease, histopathologic control is required for distinguishing non-specific OI from other differential diagnosis, especially lymphoma. In the cases of pure myositic locations and posteriorly located tumours where biopsy could damage to the optic nerve, analysis of orbital lesions in T2W IRM sequence may be helpful to distinguish idiopathic OI (IOI) from lymphoma. When the diagnostic work-up fails, a corticosteroid trial could be used, but its beneficial effect has to be cautiously interpretated before definitively diagnosing IOI. Finally, treatments used in main infllammatory orbitopathies were also reviewed.
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Affiliation(s)
- S Abad
- UMR1125, LI2P, service de médecine interne, hôpital Avicenne, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Assistance publique-hôpitaux de Paris (AP-HP), 125, route de Stalingrad, 93000 Bobigny cedex 09, France.
| | - F Héran
- Service d'imagerie, Fondation Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France.
| | - C Terrada
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, groupe hospitalier (GH) Pitié-Salpêtrière, université Paris 6, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France; Centre Roule-Péretti, 169, avenue Achille-Péretti, 92200 Neuilly-sur-Seine, France.
| | - P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, hôpital du Bocage, 2, boulevard Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - D Sène
- Service de médecine interne B, hôpital Lariboisière, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, université Sorbonne Paris Cité- Paris Diderot, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 9, avenue du Général-de-Gaulle, 92100 Boulogne-Billancourt, France; Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), 55, avenue de Paris, 78000 Versailles, France.
| | - D Saadoun
- Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, université Pierre-et-Marie Curie, AP-HP, Paris 6, 75013 Paris, France; DHU I2B, inflammation, immunopathology, biotherapy, UPMC, Paris 6, 75013 Paris, France; Centre national de référence des maladies auto-immunes et systémiques rares, 75013 Paris, France.
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, hospices Civils de Lyon, université de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Grimbert P, Vabres B, Orignac I, Lebranchu P, Clairand R, Gayet M, Smolik I, Ferron C, Corre P, Weber M. [Diagnostic value of multidisciplinary meetings on orbital inflammatory pathologies discussed in Nantes University Medical Center]. J Fr Ophtalmol 2013; 36:809-14. [PMID: 24144523 DOI: 10.1016/j.jfo.2013.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/07/2013] [Accepted: 02/19/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Observational study of the diagnoses and the treatment modalities used for orbital inflammatory pathologies discussed in multidisciplinary meetings (MDM) in Nantes University Medical Center over 4 years. MATERIAL AND METHOD A multidisciplinary meeting to discuss eyelid and orbital pathologies (excluding cancer) has been held in Nantes three times per year since October 2008. This retrospective study focuses on the cases of orbital inflammatory pathologies discussed at this meeting from October 2008 to October 2012 (49 cases included). RESULTS Twenty-eight (57%) patients were diagnosed with orbital inflammation, 16 (33%) cases with isolated myositis and 5 (10%) with dacryoadenitis. In the diagnostic work-up, orbital biopsy was performed in 64% of orbital inflammation cases, 38% of myositis cases and 80% of dacryoadenitis cases. These specimens led to the diagnosis of 9 lymphomas, 2 histiocytoses and 1 metastasis. The internal medicine work-up allowed for the diagnosis of 3 granulomatoses with polyangiitis, one patient with sarcoidosis, and one patient with tuberculosis. Despite work-up, there remained 14 (29%) idiopathic orbital inflammatory syndromes (IOIS). DISCUSSION The MDM of orbital pathology allows for the collective approach to the most difficult cases of management and is not concerned with stable orbitopathies or those presenting no diagnostic dilemma. Despite a multidisciplinary, rational etiologic work-up (frequently involving a biopsy), we find a higher rate of IOIS than reported in the literature. CONCLUSION A multidisciplinary approach appears to be useful in improving management of orbital disease.
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Affiliation(s)
- P Grimbert
- Service d'ophtalmologie du CHU de Nantes, 2, place Alexis-Ricordeau, 44000 Nantes, France.
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