Immune-mediated extraocular myositis in an adolescent following coronavirus disease 2019: A case report

A wide spectrum of ocular manifestations have been documented in patients following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nevertheless, bilateral extraocular myositis specifically associated with natural SARS-CoV-2 infection has been rarely reported. We report the case of an East Asian adolescent female who presented with right ocular discomfort and diminished visual acuity for 2 weeks. A SARS-CoV-2 infection had been confirmed via reverse transcriptase-polymerase chain reaction 10 days ago. Magnetic resonance imaging of the orbits revealed bilateral eyelid swelling and diffuse, asymmetric thickening of the extraocular muscles, suggestive of myositis. Symptoms and imaging findings improved markedly with high-dose corticosteroids; however, recurrence occurred upon rapid tapering. The inflammation ultimately resolved with a more gradual tapering regimen, and no recurrence was observed during 12 months of follow-up. This case underscores that natural SARS-CoV-2 infection can trigger immune-mediated bilateral extraocular myositis, posing vision-threatening risks. Corticosteroids are effective, but gradual withdrawal is essential to prevent relapse.