Orbital Myositis

Kubota, Toshinobu

doi:10.5772/19550

Cited by 10 publications

(10 citation statements)

References 64 publications

(73 reference statements)

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“…As idiopathic orbital myositis is a diagnosis per exclusionem , the question is raised as to when one can assume an infection is sufficiently excluded. Clinical and radiological findings in infectious myositis are similar to those of auto-immune myositis [19] and initially CRP, ESR, WBC and CSF were not suggestive of infectious disease. Although there is no consensus on diagnostic criteria for idiopathic orbital myositis, the above-mentioned clinical features are in line with what can be expected in this disease entity.…”

Section: Discussionmentioning

confidence: 96%

Intracranial actinomycosis of odontogenic origin masquerading as auto-immune orbital myositis: a fatal case and review of the literature

et al. 2019

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Background Actinomycetes can rarely cause intracranial infection and may cause a variety of complications. We describe a fatal case of intracranial and intra-orbital actinomycosis of odontogenic origin with a unique presentation and route of dissemination. Also, we provide a review of the current literature. Case presentation A 58-year-old man presented with diplopia and progressive pain behind his left eye. Six weeks earlier he had undergone a dental extraction, followed by clindamycin treatment for a presumed maxillary infection. The diplopia responded to steroids but recurred after cessation. The diplopia was thought to result from myositis of the left medial rectus muscle, possibly related to a defect in the lamina papyracea. During exploration there was no abnormal tissue for biopsy. The medial wall was reconstructed and the myositis responded again to steroids. Within weeks a myositis on the right side occurred, with CT evidence of muscle swelling. Several months later he presented with right hemiparesis and dysarthria. Despite treatment the patient deteriorated, developed extensive intracranial hemorrhage, and died. Autopsy showed bacterial aggregates suggestive of actinomycotic meningoencephalitis with septic thromboembolism. Retrospectively, imaging studies showed abnormalities in the left infratemporal fossa and skull base and bilateral cavernous sinus. Conclusions In conclusion, intracranial actinomycosis is difficult to diagnose, with potentially fatal outcome. An accurate diagnosis can often only be established by means of histology and biopsy should be performed whenever feasible. This is the first report of actinomycotic orbital involvement of odontogenic origin, presenting initially as bilateral orbital myositis rather than as orbital abscess. Infection from the upper left jaw extended to the left infratemporal fossa, skull base and meninges and subsequently to the cavernous sinus and the orbits. Electronic supplementary material The online version of this article (10.1186/s12879-019-4408-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 96%

Intracranial actinomycosis of odontogenic origin masquerading as auto-immune orbital myositis: a fatal case and review of the literature

et al. 2019

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“…Idiopathic orbital inflammations and idiopathic orbital myositis have unknown etiology but involve inflammation. They are characterized by sudden onset of orbital inflammation, periocular pain, swelling and redness of the eyelids, proptosis, ptosis, and ocular motility restrictions [ 12 ]. These differ from the signs and symptoms of orbital IgG4-related disease.…”

Section: Differential Diagnosismentioning

confidence: 99%

Orbital IgG4-Related Disease: Clinical Features and Diagnosis

Kubota

Moritani

2012

ISRN Rheumatology

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Orbital IgG4-related disease, which can occur in adults of any age, is characterized by IgG4-positive lymphoplasmacytic infiltrations in ocular adnexal tissues. The signs and symptoms include chronic noninflammatory lid swelling and proptosis. Patients often have a history of allergic disease and elevated serum levels of IgG4 and IgE as well as hypergammaglobulinemia. Orbital IgG4-related disease must be differentiated from idiopathic orbital inflammation and ocular adnexal marginal zone B-cell lymphoma to ensure appropriate and effective treatment. Systemic steroid therapy decreases the size of the lesions, but relapse often occurs when systemic steroid therapy is discontinued.

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“…They are characterized by sudden onset of orbital inflammation, periocular pain, swelling and redness of the eyelids, proptosis, ptosis, and ocular motility restrictions [12]. These differ from the signs and symptoms of orbital IgG4-related disease.…”

Section: Differential Diagnosismentioning

confidence: 99%