Orbital myositis presenting with only unilateral orbital pain

Description

A 24-year-old woman developed sudden severe periorbital pain characterised by severe, unilateral, pounding, short-lived, repetitive pain. Consequently, she was diagnosed with paroxysmal haemicrania at the first visit. There was no history of diplopia or other ophthalmic symptoms. Her physical and other neurological findings were normal. Anti-thyroid and antinuclear antibodies were negative. IgG4, soluble interleukin-2 receptor, C-reactive protein and creatine kinase levels; cerebrospinal fluid analysis; and CT scan were normal. MRI revealed enlargement and increased signal in the left medial rectus muscle on gadolinium-enhanced T1-weighted imaging suggesting orbital myositis (OM) (figure 1A,B). The patient was treated with three cycles of intravenous methylprednisolone (IVMP) followed by oral prednisolone 30 mg/day, resulting in rapid resolution of the symptoms. There was no relapse after reducing the prednisolone dosage, and MRI findings were almost resolved after 2 months of steroid therapy (figure 1C,D). The most frequently used medication of OM...

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