Intraorbital rituximab to treat orbital inflammation in a patient with active neoplasia

A 66-year-old woman presents with unilateral orbital inflammation of several years of evolution, initially classified as idiopathic orbital inflammatory disease (IOID) subtype myositis. She presented with pain, eyelid inflammation and significant elevation of intraocular pressure, as well as radiological signs of exophthalmos and superior rectus myositis. She was treated with corticosteroids, with partial response. She was diagnosed with colon adenocarcinoma, complicated with febrile neutropenia, and therefore immunosuppressive treatment was contraindicated. Treatment with intraorbital rituximab was decided, achieving resolution of symptoms and reduction of IOP. The diagnosis of neoplasia raises the possibility of paraneoplastic orbital inflammation.