Orbital myositis may occur in a number of conditions. Some patients present with orbital myositis and shortly afterwards develop a giant cell myocarditis which may follow a fulminant course. Some patients have an underlying autoimmune diseases, some are idiopathic and some die before they can be completely evaluated.

The patient typically presents with orbital myositis with:

(1) diplopia

(2) ophthalmoplegia

(3) enlarged extraocular muscles on imaging studies

(4) mononuclear cell infiltrate on extraocular muscle biopsy


Typically within a short period the patient presents with myocarditis:

(1) granulomatous inflammation with giant cells on heart biopsy

(2) heart failure

(3) life-threatening ventricular arrhythmias and conduction abnormalities


Fulminant myocarditis may necessitate heart transplant.

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