Orbital Mass as a Presenting Symptom of Crohn’s Disease: A Case Report and Literature Review
Author: Dana Cohen
Base Hospital / Institution: Federico II Hospital University of Naples
ePoster presentation
Abstract ID: 24-253
Purpose
To report a rare case of idiopathic orbital inflammation (IOI) presenting as an intraorbital mass in a patient later diagnosed with Crohn’s disease, and to review the current literature on the association between IOI and inflammatory bowel disease (IBD).
Methods
A case of a 49-year-old woman presenting with IOI and subsequently diagnosed with Crohn’s disease was documented. The patient’s clinical presentation, diagnostic process, treatment, and outcomes were detailed. A literature review was conducted using PubMed and Cochrane Library with keywords including “orbital pseudotumor,” “orbital myositis,” “idiopathic orbital inflammation,” “Crohn’s disease,” and “inflammatory bowel disease.”
Results
The patient presented with diplopia, proptosis, and orbital pain. Initial MRI showed an intraorbital lesion, and histological examination confirmed IOI. Despite corticosteroid treatment, the lesion progressed, leading to further investigation and the eventual diagnosis of Crohn’s disease. After starting oral Adalimumab, the patient’s ocular and systemic symptoms improved significantly. The literature review identified few similar cases, predominantly involving females and presenting as myositis, with the medial rectus muscle frequently affected.
Conclusion
IOI is a rare ophthalmic manifestation of IBD, with limited cases reported in the literature. It often presents with symptoms such as proptosis and diplopia and can precede the diagnosis of IBD. The pathogenesis may involve an immune response to intestinal antigens. Imaging and biopsy are crucial for diagnosis, especially to rule out malignancies. While corticosteroids are the main treatment, IOI in IBD patients may require additional immunosuppressive therapy due to lower steroid responsiveness. Recurrence is common and often coincides with IBD flare-ups, necessitating a multidisciplinary treatment approach.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Vittoria | Lanni | Federico II Hospital University of Naples |
| Adriana | Iuliano | Federico II Hospital University of Naples |
| Francesca | Gatti | Federico II Hospital University of Naples |
| Diego | Strianese | Federico II Hospital University of Naples |
