Undiscovered Islands - So Close, Yet So Far (Slides)

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Identifier walsh_2020_s3_c3-slides
Title Undiscovered Islands - So Close, Yet So Far (Slides)
Creator Magdalena Wirth, Farahna Sabiq, Mehdi Agoumi
Subject Metastatic Carcinoma, Orbital Tumors, Proptosis, Tumor
History A 30-year old female, visiting Canada from India, presented to ophthalmology with a 2-day history of right periorbital swelling, painful proptosis, fevers and chills. Initial examination suggested a clinical diagnosis of post-septal cellulitis with mild motility restriction, without optic nerve compromise, and patient was admitted and started on IV broad-spectrum antibiotics. Serologic analysis revealed mildly elevated CRP and white blood cell count. CT orbits revealed two ovoid-shaped ring-enhancing lesions in the right lateral and superior rectus muscles (Fig.1) and clear sinuses, atypical for infectious post-septal cellulitis, raising other considerations of the differential diagnosis. ACE, ANA, ANCA, HIV, and TB testing were negative. The patient received a course of oral steroids. As an inpatient, she was noted to have bradycardic episodes. Holter-monitor was unremarkable. Antibiotic and steroid treatment resulted in clinical improvement. MRI orbits was performed for further characterization, confirming the presence of the lesions in the right lateral and superior rectus muscles and an additional lesion in the left superior rectus muscle (Fig. 2). The largest ring-enhancing lesion in the right lateral rectus muscle did not show restricted diffusion, arguing against an abscess. Orbital biopsy was discussed, but deferred due to non-compliance. Given the bilaterality of these findings, a parasitic process, i.e. orbital cysticercosis was suspected, despite low eosinophil count and negative taenia solium serology. A course of albendazole, along with steroids was initiated, which led to the resolution of her symptoms. 8 weeks after her initial presentation, she presented to the ER with a 3-day history of nausea, vomiting, diarrhea, fevers and weakness. Abdominal sonography and CT ordered for iron deficiency and elevated liver enzymes showed a 3cm mass, likely arising from the neck of the pancreas, along with numerous lesions in kidneys, liver, T12 vertebral body, and periaortic/retroperitoneal lymphadenopathy (Fig. 3). A diagnostic test was performed.
Relation is Part of NANOS Annual Meeting 2020: Frank B. Walsh Session 3
Contributor Primary Magdalena Wirth
Contributor Secondary Farahna Sabiq, Mehdi Agoumi
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2020-03
Format application/pdf
Source 2020 North American Neuro-Ophthalmology Society Annual Meeting
Rights Management Copyright 2020. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s65n1j0m
Setname ehsl_novel_fbw
Date Created 2020-05-15
Date Modified 2020-05-15
ID 1551237
Reference URL https://collections.lib.utah.edu/ark:/87278/s65n1j0m
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