The Diagnostic Dilemma of Pediatric Bilateral Proptosis in a Child With Juvenile Idiopathic Arthritis.

Bilateral proptosis in a child presents a significant diagnostic dilemma, requiring a systematic radiological evaluation to differentiate between a spectrum of etiologies, from inflammatory conditions to malignancy. This challenge is amplified when associated with systemic autoimmune diseases, such as juvenile idiopathic arthritis (JIA). We report the case of a 12-year-old female patient with JIA who presented with bilateral proptosis ultimately diagnosed as idiopathic orbital inflammatory disease (IOID). This report describes the key imaging findings that led to the diagnosis, discusses the rarity of this clinical association, and emphasizes the pivotal role of a systematic radiological evaluation. Computed tomography (CT) and magnetic resonance imaging (MRI) were essential in characterizing the bilateral intraconal infiltrates, with the absence of bone destruction and specific signal characteristics helping to exclude key differential diagnoses. This case demonstrates that a rigorous radiological evaluation is essential for distinguishing pediatric IOID from its serious mimics and guiding appropriate patient management.