Acute orbital myositis preceding vesicular rash eruption in herpes zoster ophthalmicus

Abstract

Immunohistochemical analysis often reveals strong positivity for the S-100 protein by the cartilaginous component, whereas the cellular component shows positivity for CD99, vimentin, and Leu7. For diagnostic confirmation, however, immunohistostaining is used only in case of doubt when tumours such as malignant lymphoma, hemangiopericytoma, Ewing sarcoma, and soft-tissue chondroma mimic MCS. 10,11 Radical surgical excision with negative margins is the most effective treatment modality for MCS. Vision and globe salvaging resection is possible in cases of extraskeletal orbital MCS. 3,12 In our case, MCS being intraocular, enucleation was the only option for complete surgical removal, though it was done for a suspected diagnosis of retinoblastoma. Role of radiotherapy or chemotherapy in the management of MCS is limited for cases with incomplete removal or histologically aggressive tumour. 3 To the best of our knowledge, this is the first case to report intraocular MCS in the human eye. The presentation of intraocular MCS can mimic retinoblastoma. Imaging studies are of little use in differentiating intraocular MCS from retinoblastoma due to common imaging features. Being a malignant tumour with risk of distant metastasis, enucleation is the best treatment modality for intraocular MCS. Diagnostic confirmation is possible only after histopathological study of enucleated specimen.

Herpes zoster ophthalmicus-induced myositis and oculomotor nerve palsy

“…Herpes zoster orbital myositis [4] and oculomotor nerve palsy [5] are rare, but potentially serious complications of HZO. Symptoms of herpes zoster orbital myositis typically include pain and swelling around the eye, double visions, droopy eyelid, which can be very distressing and can have a significant impact on a person's quality of life [8,9].…”

“…VZV can affect almost all tissues located in the orbit, which includes the extra-ocular muscles, and can cause various forms of infection such as keratitis, scleritis, uveitis, ocular motor palsy, optic neuritis, or postherpetic neuralgia (PHN) [3]. Herpes zoster orbital myositis [4] and oculomotor nerve palsy [5] are rare conditions, occurring when the VZV reactivates in the nerves, controlling eye movement, leading to the inflammation of the extra-ocular muscles [4]. Symptoms typically include pain, double vision, and difficulty moving the eye.…”

“…Symptoms typically include pain, double vision, and difficulty moving the eye. Diagnosis is typically made through a combination of physical exam, imaging studies, and laboratory tests [4,6,7]. Treatment options may include antiviral medications, corticosteroids, and supportive care [4].…”

“…Diagnosis is typically made through a combination of physical exam, imaging studies, and laboratory tests [4,6,7]. Treatment options may include antiviral medications, corticosteroids, and supportive care [4]. Early recognition and timely medical management is important to prevent complications such as PHN and blindness [3].…”

Magnetic resonance imaging of the orbit, Part 2: Characterization of orbital pathologies

“…24 ] with short-tau inversion recovery (STIR) hyperintense fat edema, myositis with enlarged EOMs, and avid enhancement (may even precede other findings) as well as optic perineuritis. [ 33 34 ] Globe involvement such as anterior uveitis and endophthalmitis may also be recognized on MRI. Other ocular motor nerves may also show abnormal enhancement extending into their intracranial courses.…”