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A 38-year-old woman with Systemic Lupus Erythematosus (SLE) was admitted with sudden onset of painful proptosis of her left eye (figure 1A). Examination revealed a markedly proptosed left eye with chemosis, ptosis and painful reduction of eye movements. Visual acuity was preserved. Apart from coryzal symptoms, there were no other systemic features of infection. A CT scan of the orbits revealed diffuse thickening of the left lateral rectus muscle (Solid arrows) with retro-orbital fat stranding (Broken arrow), compatible with focal myositis (figure 1B,C). There was no other intracranial space occupying lesion. Her creatine kinase levels and thyroid function were normal, anti-neutrophil cytoplasmic antibody was negative but erythrocyte …
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