JAMA Clinical Challenge
Javier Munoz, MD
Razelle Kurzrock, MD
A 40-year-old man presents with left periorbital swelling and pain,which developed gradually over 2 months with no history of trauma, fever, or recent sinusitis. He has no previous medical illness and is not taking any medications. The patient denies diplopia and exposure to allergic or contact irritants. Physical examination confirms chemosis and left proptosis (Figure) without pulsation or bruit. The patient is neurologically intact, including normal pupillary response and extraocular movements. Laboratory studies are unremarkable, including normal complete blood cell count findings, negative blood cultures, and normal thyroid-stimulating hormone values.
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Author Affiliations: Drs Munoz (email@example.com) and Kurzrock are affiliated with the Investigational Cancer Therapeutics (Phase I Clinical Trials Program), MD Anderson Cancer Center, Houston, Texas.