Granulomatosis with polyangiitis presenting as anophthalmic socket pain

Area of Science:

• Ophthalmology
• Rheumatology
• Systemic Vasculitis

Background:

• Ocular and orbital manifestations are common in granulomatosis with polyangiitis (GPA).
• Anophthalmic socket pain can be debilitating and challenging to diagnose.
• Previous orbital trauma may complicate the differential diagnosis of socket pain.

Purpose of the Study:

• To report a case of anophthalmic socket pain secondary to granulomatosis with polyangiitis (GPA).
• To emphasize the importance of considering GPA in the differential diagnosis of persistent anophthalmic socket pain, even in the absence of characteristic signs.

Main Methods:

• Case report of a patient with bilateral anophthalmos presenting with refractory left socket pain.
• Initial diagnosis of orbital neuralgia was considered due to prior orbital fractures.
• Diagnosis of GPA was established through systemic work-up following pneumonia diagnosis.

Main Results:

• The patient experienced several weeks of left socket pain unresponsive to analgesics and oral steroids.
• Imaging showed no periorbital inflammation or orbital lesions.
• Socket pain resolved completely after initiating systemic treatment for GPA.

Conclusions:

• Granulomatosis with polyangiitis (GPA) should be included in the differential diagnosis for anophthalmic socket pain.
• The absence of periorbital inflammation or orbital lesions does not exclude GPA as a cause of socket pain.
• Systemic treatment of GPA led to the resolution of refractory anophthalmic socket pain.