CASE REPORT

The patient, a 23 year old student, initially presented to another hospital with swelling of his left eye. Clinical examination showed only isolated proptosis of his left eye. A computed tomographic (CT) scan of his orbits was consistent with orbital pseudotumour, for which he was given a short course of oral steroids, with good clinical response. He was then lost to follow up as he returned home from his studies.

A few months later he presented to the physicians in our hospital with a 2 week history of painful swelling of his left eye, accompanied by polyarthralgia, fever with rigors, and lethargy. Further questioning showed he had mild photosensitivity and frequent mouth ulcers of several months’ duration. He had not been receiving any other drug before the onset of symptoms. At the time of admission he was clearly unwell and extremely lethargic, with a temperature of 37.4°C. He had no facial rash, but he did have tender proptosis of his left eye. There was no associated ophthalmoplegia. He …