Case Report

Successful Treatment of Idiopathic Orbital Inflammatory Disease with Leflunomide: A Case Report

Authors: Anna Marino MD, William M. Wason MD, PhD

Abstract

Abstract:Orbital pseudotumor, also known as idiopathic orbital inflammatory disease (IOID), is an idiopathic inflammatory process within the orbit. The potential for permanent visual impairment makes this disease important to diagnose and treat. While oral corticosteroids are the mainstay of therapy, they can have significant toxicity when used for long periods of time. We present a case of IOID that was successfully treated with leflunomide after methotrexate was discontinued for toxicity-related issues. To our knowledge, use of leflunomide for this condition has not previously been reported in the literature.

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References

References1. Lutt JR, Lim LL, Phal PM, et al. Orbital inflammatory disease. Semin Arthritis Rheum 2008;37:207–222.LuttJR]]LimLL]]PhalPM&etal;Orbital inflammatory disease.Semin Arthritis Rheum200837207-2222. Gordon LK. Orbital inflammatory disease: a diagnostic and therapeutic challenge. Eye 2006;20:1196–1206.GordonLKOrbital inflammatory disease: a diagnostic and therapeutic challenge.Eye2006201196-12063. Yuen SJ, Rubin PA. Idiopathic orbital inflammation: distribution, clinical features and treatment outcome. Arch Opthalmol 2003;121:491–499.YuenSJ]]RubinPAIdiopathic orbital inflammation: distribution, clinical features and treatment outcome.Arch Opthalmol2003121491-4994. Anderson J, Thomas T. Orbital pseudotumour presenting as orbital cellulitis. CJEM 2006;8:123–125.AndersonJ]]ThomasTOrbital pseudotumour presenting as orbital cellulitis.CJEM20068123-1255. Smith JR, Rosenbaum JT. A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol 2001;85:1220–1224.SmithJR]]RosenbaumJTA role for methotrexate in the management of non-infectious orbital inflammatory disease.Br J Ophthalmol2001851220-12246. Hatton MP, Rubin PA, Foster CS. Successful treatment of idiopathic orbital inflammation with mycophenolate mofetil. Am J Ophthalmol 2005;140:916–918.HattonMP]]RubinPA]]FosterCSSuccessful treatment of idiopathic orbital inflammation with mycophenolate mofetil.Am J Ophthalmol2005140916-9187. Prendiville C, O’Doherty M, Moriarty P, et al. The use of infliximab in ocular inflammation. Br J Ophthalmol 2008;92:823–825.PrendivilleC]]O’DohertyM]]MoriartyP&etal;The use of infliximab in ocular inflammation.Br J Ophthalmol200892823-8258. Schafranski MD. Idiopathic orbital inflammatory disease successfully treated with rituximab. Clin Rheumatol 2009 28:225–226.SchafranskiMDIdiopathic orbital inflammatory disease successfully treated with rituximab.Clin Rheumatol200928225-2269. Baughman RP, Lower EE. Leflunomide for chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2004;21:43–48.BaughmanRP]]LowerEELeflunomide for chronic sarcoidosis.Sarcoidosis Vasc Diffuse Lung Dis20042143-4810. White DH, Lynskey NV, Jones PB. Leflunomide use in New Zealand. A national prospective post-marketing study. Intern Med J 2009;39:95–102.WhiteDH]]LynskeyNV]]JonesPBLeflunomide use in New Zealand. A national prospective post-marketing study.Intern Med J20093995-10211. Kaltwasser JP. Leflunomide in psoriatic arthritis. Autoimmun Rev 2007;6:511–514.KaltwasserJPLeflunomide in psoriatic arthritis.Autoimmun Rev20076511-51412. Roy M. Early clinical experience with leflunomide in uveitis. Can J Ophthalmol 2007;42:634.RoyMEarly clinical experience with leflunomide in uveitis.Can J Ophthalmol200742634