Orbital infarction and melting in a patient with systemic lupus erythematosus

Objective: To present a patient with systemic lupus erythematosus who devel oped infarction and melting of the orbit secondary to her systemic disease, Design: A case report. Participant A 61-year-old white woman with a 5-year history of systemic lup us erythematosus. Methods: The patient presented with left orbital pain, limitation of extrao cular movements, and a fistula from the ethmoid sinus to the upper eyelid. A detailed examination with computerized tomography, ultrasound, and a comp rehensive medical evaluation with laboratory testing was performed. Histopa thologic analysis with special stains of the orbital tissues was also perfo rmed. Results: Histopathologic examination of the biopsy specimens revealed the f eatures of an inflammatory process involving the orbit, similar to a pannic ulitis. These include a lymphocytic reaction with a predominance of plasma cells, vasculitis with occlusion, and thickening of the vessel walls, necro sis, and hyalinization of fat. Conclusion: This is a unique case in which infarction and melting of the en tire orbital structures occurred in the presence of systemic lupus erythema tosus. The underlying disease process is a lupus-related panniculitis. The authors stress that this is a very rare entity and that other diseases shou ld be ruled out before entertaining this diagnosis.