An Orbital Pseudotumor Secondary to Systemic Lupus Erythematosus: A Case Report

Nonspecific orbital inflammation (NSOI), the primary cause of painful orbitopathy mostly in adults, can either manifest as localized or diffused. Periorbital edema or swelling is the most common sign followed by proptosis. NSOI or orbital pseudomotor secondary to systemic lupus erythematosus (SLE) is very uncommon in the Kingdom of Saudi Arabia. This is the first reported case from Saudi Arabia. The patient first presented to the outpatient department during her gestational period. Her chief complaint was right eye swelling and pain when she woke up in the morning. Her past medical history was positive for irritable bowel disease and SLE. A slit lamp examination revealed chemosis with conjunctival injections in the right eye and mild temporal chemosis in the left eye. Funduscopic examination after pupillary dilation revealed hyperemic discs with venous tortuosity more prominent in the right eye. Serum albumin level was low at 29 g/L. Orbital magnetic resonance imaging without contrast showed bilateral diffuse preseptal soft tissue swelling more prominent on the right side with diffuse bilateral congestion of intraorbital fat, including intraconal and extraconal fat. There was associated fat stranding around the optic nerves bilaterally. The bilateral extraocular muscles showed a diffusely increased T2 signal compatible with edema. The patient was given a bolus of intravenous methylprednisolone for three days. She had a satisfactory recovery. Early diagnosis is important to rule out other differential diagnoses, such as orbital cellulitis and lymphoma.