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Title	An unusual presentation of Wegener's granulomatosis : a case report
Abstract Nr.	A2043

Purpose	To report an unusual presentation of Wegener's granulomatosis into the orbit, in a 55-year old woman.
Methods	A full clinical workup including CT scan, MRI, echography, electromyelography, orbital biopsy, blood count and overall ophthalmological examination was performed.
Results	A 55-year-old woman presented with swelling of the right upper and lower eye lid, diplopia and proptosis. In the medical history there was a chronic maxillary sinusitis, treated with antibiotics, steroids and two draining surgeries. Examination of the specimens taken during the draining surgery revealed an infection with MRSA and Aspergillus Fumigatus. The patient was then referred to our department with suspicion of an Aspergillus orbital cellulitis. Biopsy of the orbital mass demonstrated an orbital vasculitis. Further systemic workup of these vasculitis including CT thorax, electromyelography and blood count confirmed the unexpected diagnosis of Wegener's granulomatosis. Systemic treatment with immunosuppressive agents led to a good response.
Conclusion	Orbital inflammation can occur with or without obvious systemic manifestations of Wegener's granulomatosis. It may represent the first sign of Wegener's granulomatosis that enables the physician to diagnose this potentially lethal disease.

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