A rare case of early massive monomuscular  fibrosis causing severe unilateral euthyroid Graves’ ophthalmopathy in a smoker patient with dyslipidemia

Abstract BackgroundGraves’ ophtahlmopathy (GO) is an autoimmune manifestation of orbit affecting about 25% of patients with Graves’ disease (GD). Autoreactive T cells involved in thyroid autoimmunity can recognize the thyroid stimulating receptor (TSHr) expressed in orbit tissues of GO patients. Clinical manifestations of GO are rather different depending of the presence of some risks factors as smoke, hyperthyroidism duration, age, biological activity of anti TSHr antibodies (TSH-R-Ab) and metabolic diseases.Case presentation:here we present a rare case of euthyroid single muscular GO in a 50 years old patient, he was smoker and had dyslipidemia from several years. The patient experienced a very rapid and severe depression of ocular motility of the right eye that causes an uncorrectable and constant diplopia severely affecting his quality of life. He was euthyroid and TSH-R-Ab plasmatic levels were only slightly elevated. Intravenous corticosteroids pulse therapy was partially effective and two rounds of wall orbital surgical decompression was necessary. A massive mono-muscular fibrosis was evidenced by biopsy of right inferior rectus muscle.Conclusionssevere unilateral, mono-muscular GO in a euthyroid Graves’ patient was found to be sustained by rapid and massive fibrosis of the inferior rectus muscle of right orbit, the clarification of pathogenetic mechanisms of these GO clinical forms requires further studies.