Refractory Orbital Myositis in Systemic Lupus Erythematosus A Role for Rituximab

Joana Rodrigues Morais; Raquel Rodrigues Santos; Paula Pires Costa; Tomás Fonseca; Fátima Farinha

doi:10.12890/2021_003038

Refractory Orbital Myositis in Systemic Lupus Erythematosus A Role for Rituximab

Eur J Case Rep Intern Med. 2021 Dec 10;8(12):003038. doi: 10.12890/2021_003038. eCollection 2021.

Authors

Joana Rodrigues Morais¹, Raquel Rodrigues Santos¹, Paula Pires Costa², Tomás Fonseca³, Fátima Farinha³

Affiliations

¹ Internal Medicine Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal.
² Internal Medicine Service, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
³ Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal.

Abstract

Orbital myositis in systemic lupus erythematosus (SLE) is a rare entity with risk of serious complications. Timely treatment with effective immunosuppressors is desirable. We report a case of a 32-year-old female patient with SLE who presented with an acute ocular pain and extraorbital muscle thickening, consistent with orbital myositis. Association with SLE was made after exclusion of other aetiologies. Due to refractoriness to steroids, off-label rituximab was initiated with clinical and imaging parameter improvement.

Learning points: Orbital myositis is a rare entity that can be present in some autoimmune diseases or mimic other common ocular conditions, such as orbital cellulitis or thyroid orbitopathy.In SLE, it may be the form of presentation of the disease or the only manifestation of active disease, even without elevation of inflammatory biomarkers.Generally, patients with orbital myositis have an excellent response to high-dose corticosteroid therapy, but the risk of recurrence or refractoriness is not negligible.

Keywords: Orbital myositis; corticosteroid; rituximab; systemic lupus erythematosus.