Introduction. The presence of bilateral exophthalmos and palpebral,
periorbital edema associated with hyperthyroidism is most often considered as
an initial sign of Graves? ophthalmopathy. However, in up to 20% of cases,
Graves? ophthalmopathy might precede the occurrence of hyperthyroidism, which
is very important to be considered in the differential diagnosis, especially
if it is stated as unilateral. Among other less common causes of
non-thyroid-related orbitopathy, orbital lymphoma represents rare conditions.
We presented of a patient with Graves? disease, initially manifested as
bilateral orbitopathy and progressive unilateral exophthalmos caused by the
marginal zone B-cell non-Hodgkin lymphoma of the orbit. Case report. A
64-yearold man with the 3-year history of bilateral Graves? orbitopathy and
hyperthyroidism underwent the left orbital decompression surgery due to the
predominantly left, unilateral worsening of exophthalmos resistant to the
previously applied glucocorticoid therapy. A year after the surgical
treatment, a substantial exophthalmos of the left eye was again observed,
signifying that other non-thyroid pathology could be involved. Orbital
ultrasound was suggestive of primary orbital lymphoma, what was confirmed by
orbital CT scan and the biopsy of the tumor tissue. Detailed examinations
indicated that the marginal zone B-cell non-Hodgkin lymphoma extended to IV
- B-b CS, IPI 3 (bone marrow infiltration: m+ orbit+). Upon the completion of
the polychemiotherapy and the radiation treatment, a complete remission of
the disease was achieved. Conclusion. Even when elements clearly indicate the
presence of thyroid-related ophthalmopathy, disease deteriorating should
raise a suspicion and always lead to imaging procedures to exclude
malignancy.
Orbital lymphoma associated with Graves’ disease: A case report
