Orbital involvement as the initial manifestation of sarcoidosis: Magnetic resonance imaging findings

A 74-year-old man had diplopia, painful right ophthalmoplegia, proptosis, c onjunctival injection, and facial skin lesions. Magnetic resonance imaging (MRI) revealed infiltration of the right intraorbital adipose tissue. Lesio ns were mixed low- and high-signal on T2-weighted images and enhanced on fa t-suppressed T1-weighted postcontrast images. A skin biopsy revealed numero us noncaseating granulomas consistent with sarcoidosis. Treatment with cort icosteroids and chlorambucil led to a full clinical recovery. Sarcoidosis s hould be considered in the evaluation of orbital pseudotumor in elderly pat ients, even if no systemic manifestations of sarcoidosis are present.