Abstract
A patient with past medical history of sinusitis and saddle nose deformity presented to the ophthalmology clinic complaining of left eye pain, swelling, and double vision for several days. Visual acuity was 20/20 OU without an afferent pupillary defect, and intraocular pressures were normal. Exam was remarkable for supraduction deficit and 4 mm of proptosis in the left eye. Posterior examination was remarkable for choroidal folds and mild nerve edema in the left eye as well. The patient underwent MRI Brain and Orbits which revealed an orbital soft tissue mass consistent with orbital pseudotumor. Orbital biopsy was performed revealing nonspecific chronic inflammation. Blood work was positive for high titers of c-ANCA positivity. In conjunction with Rheumatology, a clinical diagnosis of Granulomatosis with Polyangiitis was made. The patient’s clinical course was marked by several relapses and periods of medical noncompliance, however ultimately the patient responded well to high dose steroids and Rituximab. At the most recent follow up, the patient continues to have 20/20 vision in both eyes, and the side of the soft tissue mass has diminished, though remains present.
Presentation Date: 07/24/2025
Issue Date: 01/23/2026
