Hernández Pardines F, Serra Verdú M C, Bernal Vidal A, Mayol Belda J M, Mengual Verdú E
Servicio de Oftalmología, Hospital de San Juan de Alicante, Alicante, España.
Servicio de Oftalmología, Hospital de San Juan de Alicante, Alicante, España.
Arch Soc Esp Oftalmol (Engl Ed). 2019 Apr;94(4):192-195. doi: 10.1016/j.oftal.2018.09.002. Epub 2018 Oct 22.
The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed. This was of soft tissue density, and included the external rectus muscle that exerts a mass effect on the optic nerve by displacing it medially. Many lytic bone diffuse lesions with salt and pepper pattern were found in the calotte. A rectus lateral muscle and bone biopsy of the sacral wing was performed, resulting in metastasis of carcinoma compatible with mammary origin. An atypical case is presented of horizontal diplopia in the context of a patient with a severe constitutional picture with no established diagnosis, in which the biopsy of the lateral rectum was key to the confirmation diagnosis.
该病例涉及一名58岁女性，无相关病史，因一周前出现双眼复视前来就诊。同时伴有两个月前开始的肋部疼痛、呼吸困难、极度乏力和体重减轻。急诊科的血液分析显示高钙血症、肾衰竭和双血细胞减少。胸部X光显示溶骨性骨病变，最初诊断为多发性骨髓瘤伴骨外受累。除了相应的检查外，对于水平性复视，还进行了无对比剂的头颅CT扫描，发现左眼眶外侧壁相邻处有一病变。该病变呈软组织密度，累及外直肌，向外直肌对内侧视神经产生占位效应。在颅骨发现许多呈椒盐样的溶骨性弥漫性病变。对骶骨翼的外直肌和骨进行了活检，结果显示为符合乳腺来源的癌转移。本文介绍了一例非典型病例，一名患有严重全身症状且未确诊的患者出现水平性复视，其中外直肌活检对确诊起到了关键作用。
