A case of a rapidly progressing, recurrent orbital mass

We present a case of fast-growing, recurrent orbital mass which was ultimately diagnosed as sarcoidosis in a patient who lacked systemic symptoms.

A case report was conducted.

A 58-year-old woman from Pakistan presented with a ortbial mass that is hyperintense orbital mass on MRI. Excisional biopsy and pathology revealed non-necrotizing granulomatous inflammation. Negative AFB culture, GMS, and flow cytometry ruled out TB and lymphoma. Chest X-ray was unremarkable. ACE and Lysozyme levels were marginally elevated. She presented with symptomatic recurrence of mass requiring repeat excision. Chest CT confirmed the presence of pulmonary nodules and hilar lymphadenopathy. She was started on corticosteroids and methotrexate with resolution of local inflammation and residual mass effect.

Chest CT has higher sensitivity to aid definitive diagnosis in the setting of negative chest X-ray. Surgical treatment may be useful for diagnostic and therapeutic purposes. Subsequent long-term treatment with corticosteroids and antimetabolites has shown great response.