title: Granulomatous orbital inflammation associated with intraorbital titanium-impregnated acetate fiber.
abstract: Herein we report a 52-year-old man with subacute right-sided proptosis and diffuse intraconal enhancing abnormality on MRI. Orbital biopsy revealed granulomatous inflammation consistent with idiopathic orbital inflammatory syndrome (IOIS), or orbital pseudotumor. However, further examination under polarizing light microscopy also revealed acetate fiber fragments within the orbit. Prominent speckles within the acetate fibers were identified as titanium by Energy Dispersive X-ray Analysis (EDXA). Acetate impregnated with titanium (as a delustrant) is a common synthetic fiber used in textile and clothing manufacture. The mechanism for entrance into the orbit in this case is not known. Granulomatous idiopathic orbital inflammatory syndrome without local or systemic cause is an uncommon clinical entity, with less than 50 cases reported in the literature. Predominance of lacrimal gland (and thus superficial) involvement in granulomatous IOIS suggests the possibility of occult foreign body in such cases.
authors.affiliation: Cleveland Clinic, Cole Eye Institute, Cleveland, Ohio 44195, USA.
authors.forename: Aimee V
authors.initials: AV
authors.lastname: Chappelow
authors.forename: James T
authors.initials: JT
authors.lastname: McMahon
authors.forename: Curtiss L
authors.initials: CL
authors.lastname: Jones
authors.forename: Greg
authors.initials: G
authors.lastname: Kosmorsky
mesh_terms: D001707:Biopsy, Needle; D001774:Blood Chemical Analysis; D003287:Contrast Media; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D016727:Orbital Pseudotumor / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011241:Prednisone / Q000627:therapeutic use; D014025:Titanium / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C101914:titanium fiber; C009495:titanium dioxide; D014025:Titanium; D011241:Prednisone