A Case of a Rapidly Progressing, Recurrent Orbital Mass
Keywords:
orbital mass, granuloma, sarcoidosis, lymphoma, recurrentAbstract
Background and aim: We present a case of fast-growing, recurrent orbital mass which was ultimately diagnosed as sarcoidosis in a patient who lacked systemic symptoms.
Methods: A case report was conducted.
Results: A 58-year-old woman from Pakistan presented with a hyperintense orbital mass on MRI. Excisional biopsy and pathology revealed non-necrotizing granulomatous inflammation. Negative acid-fast stain, GMS, and flow cytometry ruled out TB and lymphoma. Chest X-ray was negative for any hilar lymphadenopathy or nodules. ACE and Lysozyme levels were marginally elevated. Rheumatology did not make a definitive diagnosis or treatment plan due to lack of systemic findings. Less than 3 months after orbitotomy, she presented with symptomatic recurrence of mass requiring repeat excision. Chest CT confirmed the presence of pulmonary nodules and hilar lymphadenopathy, supporting the diagnosis of sarcoidosis. She was started on corticosteroids and methotrexate with resolution of local inflammation and residual mass effect.
Conclusions: Sarcoidosis should be considered in the differential of an orbital mass, even in the absence of systemic symptoms. Early utilization of chest CT may help with definitive diagnosis in the setting of negative chest X-ray. Surgical treatment may be useful for diagnostic and therapeutic purposes providing fast symptomatic relief. Surgical management may be necessary in cases involving the optic nerve or extraocular muscles. Subsequent long-term treatment with corticosteroids and antimetabolites has shown great response.
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