[A 44-year-old patient with cardial carcinoma and paraneoplastic orbital disease].
METHODS
Bilateral orbital involvement with chemosis, protrusion and reduced vision developed in a 44-year-old man 12 weeks after carcinoma of the cardia with lymph node metastases and peritoneal carcinomatosis had been diagnosed and palliative chemotherapy with a cycle of leucovorin and 5-fluorouracil had been concluded.


METHODS
Computed tomography excluded a retrobulbar metastasis. Thyroid hormone concentration was normal as was the thyroid autoantibody titre. There was also no evidence on sonography of endocrine orbital disease. These findings established the diagnosis of paraneoplastic orbital myositis.


METHODS
The symptoms briefly regressed on initial treatment with systemically administered high doses of corticosteroids. Renewed marked eyeball protrusion with incipient visual loss was treated with conjunctival drainage and tarsorrhaphy, as well as radiotherapy to the retrobulbar space. This achieved significant improvement. Shortly thereafter the patients died of acute bleeding from the primary tumour.


CONCLUSIONS
In patients with an underlying malignancy and symptoms of orbital myositis orbital involvement as part of a paraneoplastic syndrome should be diagnosed once other causes have been excluded.
Eckel
F
F
II. Medizinische Klinik, Klinikums rechts der Isar, Technische Universität München.
Ugi
I
I
Schmidt
T
T
Lersch
C
C
D000230:Adenocarcinoma / Q000150:complications*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002299:Cardia; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009220:Myositis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009916:Orbital Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010257:Paraneoplastic Syndromes; D013274:Stomach Neoplasms / Q000150:complications*; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones