title: Idiopathic sclerosing inflammation of the orbit: a case of steroid-responsive disease in a patient with auto-immune hemolytic anemia.
abstract: OBJECTIVE
  Idiopathic sclerosing orbital inflammation (ISOI) has been categorized by some authors as a unique clinicopathologic entity, separate from the heterogeneous group of disorders known collectively as nonspecific orbital inflammation. Histologic similarity and clinical association with other fibrosclerosing conditions has been shown. The authors present a case of ISOI in conjunction with autoimmune hemolytic anemia.
  
  
  METHODS
  A 59-year-old woman with a history of hemolytic anemia had left upper lid swelling, periocular pain, proptosis, and restriction of ocular motility. Magnetic resonance imaging (MRI) showed a homogeneously enhancing lateral orbital mass. Biopsy revealed dense fibrous connective tissue with a paucicellular infiltrate, consistent with ISOI, and treatment with prednisolone 60 mg/day was instituted.
  
  
  RESULTS
  At 4-week review, the proptosis had settled and the patient regained full range of extraocular movements. At 14 months, the response was sustained and repeat MRI showed a 70% reduction in size of the mass.
  
  
  CONCLUSIONS
  The first known case of ISOI and hemolytic anemia is presented. Despite dense fibrosis histologically, steroid responsiveness can be encountered in cases of ISOI. An early, aggressive approach to management is recommended, and corticosteroids should be considered as a treatment option.
authors.affiliation: Oculoplastics & Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide--South Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Billing
authors.forename: J
authors.initials: J
authors.lastname: Hsuan
authors.forename: D
authors.initials: D
authors.lastname: Selva
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications* / Q000188:drug therapy; D005094:Exophthalmos; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009915:Orbit / Q000473:pathology*; D016727:Orbital Pseudotumor / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D012598:Sclerosis
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone