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Idiopathische orbitale Myositis

Erstbeschreibung der Therapie mit dem NSAID Naproxen

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Zusammenfassung

Hintergrund

Bei der idiopathischen orbitalen Myositis handelt es sich um eine entzündliche Erkrankung der äußeren Augenmuskulatur, die mit periorbitalem Schmerz und Schwellung (Pseudotumor), Exophthalmus, Ptosis, Diplopie, Ophthalmoplegie, konjunktivaler Reizung und Chemosis einhergehen kann. Sie tritt meist einseitig auf und führt nicht zu einem Visusverlust. Das häufige Auftreten von Rezidiven ist typisch und kann zur orbitalen Fibrose und zum Exophthalmus führen. Die idiopathische orbitale Myositis stellt eine Ausschlussdiagnose dar. Differenzialdiagnostisch müssen akute Infektionen, postinfektiöse Prozesse und autoimmunologische Systemerkrankungen, chronisch-entzündliche Darmerkrankungen, Schilddrüsenfunktionsstörungen und paraneoplastische Phänomene als Ursache ausgeschlossen werden.

Kasuistik

Wir berichten über 2 Jugendliche mit idiopathischer rezidivierender orbitaler Myositis. Therapeutisch kommen in erster Linie orale Kortikosteroide in Frage. Nichtsteroidale Antiphlogistika stellen bei Kontraindikationen eine Therapiealternative dar. Bei ausgeprägter Adipositas und polyzystischem Ovar der weiblichen Patientin wurde das nichtsteroidale Antiphlogistikum Naproxen initial und im Verlauf zweier Rezidive mit sehr gutem Erfolg eingesetzt. Der Junge wurde mit oralen Glukokortikoiden initial und im Rezidiv erfolgreich behandelt.

Schlussfolgerung

Nichtsteroidale Antiphlogistika können beim Vorliegen von Kontraindikationen oder bei häufig rezidivierendem Verlauf in der Behandlung der idiopathischen orbitalen Myositis eine Alternative zu Kortikosteroiden sein.

Abstract

Background

Idiopathic orbital myositis, an inflammatory process of the exterior ocular muscles, clinically manifests as orbital pseudotumor, diplopia, blepharoptosis, periorbital pain and swelling, ophthalmoplegia, and conjunctivitis and/or chemosis. Involvement is generally unilateral. Orbital myositis does not cause visual impairment. Chronic or recurrent myositis may lead to orbital fibrosis or exophthalmos. Differential diagnoses include autoimmune diseases, infectious diseases, paraneoplastic syndromes and malignancy, Graves' disease, and chronic inflammatory bowel disease.

Case report

We report two cases of adolescents with idiopathic recurrent orbital myositis. Although treatment response to systemic glucocorticoids is generally rapid, we chose to treat the girl with the nonsteroidal antiinflammatory drug naproxen because of obesity and polycystic ovary syndrome. Treatment response was rapid at onset and in the course of two relapses. The boy was successfully treated with oral glucocorticoids at onset and during one relapse.

Conclusion

Nonsteroidal antiinflammatory drugs should be considered as an alternative treatment in idiopathic orbital myositis especially when glucocorticoids are contraindicated or in patients suffering from frequent relapses.

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Authors and Affiliations

  1. Sektion Pädiatrische Rheumatologie, Universitätskinderklinik, Universität Würzburg

    H. J. Girschick

  2. Universitätsaugenklinik, Universität Würzburg

    F. Sulimma & W. Waller

  3. Frauenklinik, Universität Würzburg

    G. Girschick

  4. Abteilung Kinderradiologie, Institut für Radiologie, Universität Würzburg

    A. Trusen

  5. Funktionsbereich Pädiatrische Rheumatologie, Universitätskinderklinik, Josef-Schneider-Straße 2, 97080 , Würzburg

    H. J. Girschick

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  1. H. J. Girschick
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  2. F. Sulimma
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  3. G. Girschick
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  5. W. Waller
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Correspondence to H. J. Girschick.

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Girschick, H.J., Sulimma, F., Girschick, G. et al. Idiopathische orbitale Myositis. Monatsschr Kinderheilkd 152, 307–311 (2004). https://doi.org/10.1007/s00112-002-0637-2

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