Miositis orbitaria, una causa de oftalmoplejia dolorosa en pediatría / Orbital myositis, a cause of pediatric painful ophthalmoplegia

INTRODUCCIÓN: La miositis orbitaria (MO) es un proceso inflamatorio grave de etiología desconocida que compro mete los músculos extraoculares. La presentación en edad pediátrica es rara y con frecuencia afecta a más de un individuo de una familia, lo que sugiere algún grado de predisposición genética. OBJETIVO: Describir un caso de miositis orbitaria de presentación en edad pediátrica, sus características clínicas, y la utilidad de la imagen por resonancia magnética para la confirmación del diagnóstico. CASO CLÍNICO: Paciente femenina de 13 años que presenta cefalea aguda, dolor periorbitario derecho, exacerbado con los movimientos oculares y visión borrosa a quien se le realizaron estudios para miopatía tiroidea, enfermedades infecciosas, autoinmunidad y cáncer que fueron negativos. En la imagen por resonancia magnética se evidenció miositis del músculo recto medio derecho, sin evi dencia de neuritis óptica. Recibió tratamiento con glucocorticoides sistêmicos intravenosos seguido de esteroides orales con mejoría clínica completa. CONCLUSIONES: La MO tiene etiología desconocida, y puede tener un curso maligno. Dada su presentación clínica inespecífica, el estudio diagnóstico diferencial debe ser amplio, y su estudio debe considerar realizar resonanacia magnética. El inicio temprano del tratamiento con esteroides evita el daño permanente de los músculos extraoculares.

INTRODUCTION: Orbital myositis (OM) is a serious inflammation of extraocular muscles with unknown etiology. Pe diatric presentation is rare and often affects more than one individual in a family, suggesting a genetic predisposition. OBJECTIVE: To describe a pediatric case of orbital myositis, its clinical characteristics, and the usefulness of MRI for confirming the diagnosis. CLINICAL CASE: A 13-year-old female patient presenting with acute headache, right periorbital pain, exacerbated by eye movements, and blurred vision. We ruled out thyrotoxic myopathy, infectious diseases, autoimmunity, and malignancy. An MRI showed right medial rectus muscle myositis and no evidence of optic neuritis. She was treated with intravenous systemic glucocorticoids followed by oral steroids with complete clinical resolution. CONCLUSIONS: OM has unknown etiology and can present a malignant course. Due to its unspecific clinical presentation, a comprehensive differential diagnosis should be made and it should consider performing MRI. Early treatment avoids permanent damage of extraocular muscles.

[Orbital myositis, a cause of pediatric painful ophthalmoplegia]. / Miositis orbitaria, una causa de oftalmoplejia dolorosa en pediatría.

INTRODUCTION: Orbital myositis (OM) is a serious inflammation of extraocular muscles with unknown etiology. Pe diatric presentation is rare and often affects more than one individual in a family, suggesting a genetic predisposition. OBJECTIVE: To describe a pediatric case of orbital myositis, its clinical characteristics, and the usefulness of MRI for confirming the diagnosis. CLINICAL CASE: A 13-year-old female patient presenting with acute headache, right periorbital pain, exacerbated by eye movements, and blurred vision. We ruled out thyrotoxic myopathy, infectious diseases, autoimmunity, and malignancy. An MRI showed right medial rectus muscle myositis and no evidence of optic neuritis. She was treated with intravenous systemic glucocorticoids followed by oral steroids with complete clinical resolution. CONCLUSIONS: OM has unknown etiology and can present a malignant course. Due to its unspecific clinical presentation, a comprehensive differential diagnosis should be made and it should consider performing MRI. Early treatment avoids permanent damage of extraocular muscles.

Orbital myosits in a patient with Behçet's disease / Miosite orbitária em paciente com doença de Behçet

Abstract The etiological diagnosis of orbital myositis (OM) is a challenge. Although it has been associated with previous infectious disease, diseases with autoimmune background, thyroidopathies or with paraneoplasic syndrome, most of them still remain as idiopathic. We describe here a case of OM uncovering a Behçet disease that is considered a rare cause for this kind of eye involvement.

Resumo Trata-se de um caso de ceratite bilateral e simultânea por Acremonium relacionada ao uso intermitente e sem respeitar a lateralidade O diagnóstico etiológico da miosite orbitária (MO) é desafiador. Embora ela tenha sido relacionada com doenças infecciosas prévias, doenças associadas à autoimunidade, tireoidopatias ou síndromes para neoplásicas, a maioria delas ainda permanece como idiopática. Descreve-se aqui, um caso de MO revelando o diagnóstico de doença de Behçet, doença considerada como uma causa pouco comum para este tipo de envolvimento ocular.