| Identifier |
walsh_2018_s1_c2-2 |
| Title |
Lumps and Bumps - Slides |
| Creator |
Wayne Tie, Martha P. Schatz, MD |
| Subject |
Myopathy |
| History |
A 37 year-old man with no PMH presented with bilateral painful red eyes and progressive proptosis for several months. He noted the increasing protrusion of both eyes, but only complained of recent onset of pain in both eyes over the last four days. He also developed worsening blurry vision in both eyes with the left eye worse than right. Patient had no personal or family history of cancer. His initial examination showed right eye VA of 20/50 and left eye 20/100 at near and massive proptosis and lagophthalmos of both eyes with near complete corneal exposure bilaterally. On his external exam, the patient also had bilaterally enlarged lacrimal glands and submandibular lymph nodes as well as diffusely restricted extraocular movements. He presented with IOPs of 24 OD and 39 OS, reactive pupils, and a 1+ RAPD OS. Patient's ophthalmic exam showed diffusely dry corneal epithelium of both eyes and an inferior corneal ulcer of the left eye. Fundus exam was otherwise unremarkable. Initial CBC and CMP on presentation were only remarkable for mildly elevated WBC. CT orbit w/o contrast demonstrated massive enlargement of the bilateral lateral rectus, inferior oblique, and medial rectus muscles along with severe proptosis and straightening of the optic nerve. Patient was admitted to the hospital for inpatient evaluation. |
| Disease/Diagnosis |
IgG4 associated infiltrative disease |
| Presenting Symptom |
History and Exam A 37 year-old man with no PMH presented with bilateral painful red eyes and progressive proptosis for several months. He noted the increasing protrusion of both eyes, but only complained of recent onset of pain in both eyes over the last four days. He also developed worsening blurry vision in both eyes with the left eye worse than right. Patient had no personal or family history of cancer. His initial examination showed right eye VA of 20/50 and left eye 20/100 at near and massive proptosis and lagophthalmos of both eyes with near complete corneal exposure bilaterally. On his external exam, the patient also had bilaterally enlarged lacrimal glands and submandibular lymph nodes as well as diffusely restricted extraocular movements. He presented with IOPs of 24 OD and 39 OS, reactive pupils, and a 1+ RAPD OS. Patient's ophthalmic exam showed diffusely dry corneal epithelium of both eyes and an inferior corneal ulcer of the left eye. Fundus exam was otherwise unremarkable. Initial CBC and CMP on presentation were only remarkable for mildly elevated WBC. CT orbit w/o contrast demonstrated massive enlargement of the bilateral lateral rectus, inferior oblique, and medial rectus muscles along with severe proptosis and straightening of the optic nerve. Patient was admitted to the hospital for inpatient evaluation. |
| Date |
2018-05 |
| References |
None. |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
2018 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting 2018: Frank B. Walsh Session 1 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6040 |
| Rights Management |
Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s61s0tvw |
| Setname |
ehsl_novel_fbw |
| ID |
1326571 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s61s0tvw |
