Clinical Challenge: An Orbital Hickam's Dictum.

Clinical Challenge: An Orbital Hickam's Dictum.

Surv Ophthalmol. 2016 Mar 16;

Authors: Wilson ME, Thornton S, Murchison AP, Bilyk JR

Abstract
A 53-year old man with hyperthyroidism presented with asymmetric proptosis and diplopia. Thyroid stimulating immunoglobulin was elevated, suggesting active thyroid eye disease (TED). Imaging of the orbits revealed enlargement of the extraocular muscles including irregular enlargement of the left lateral rectus muscle. Biopsy of the lateral rectus muscle demonstrated infiltration of the muscle with Bcl-2 positive B lymphocytes, consistent with chronic lymphocytic leukemia (CLL). Evaluation for systemic lymphoproliferative disease was negative. The patient was treated with orbital radiotherapy at specific dosages for both TED and CLL. He responded well to therapy with a reduction in proptosis and diplopia, and no evidence of recurrent CLL.

PMID: 26994869 [PubMed - as supplied by publisher]

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