Exophthalmus as first symptom of a metastasing carcinoid of the ileum
B. Heinemann-Vernaleken1, J. Schmidbauer1, M. Lang1, C. Moser2
Introduction: Carcinoids are epithelial tumours, arising from the enterochromaffine cells of the APUD-system, producing Serotonine, Callicreine, Tachycinines and Prostaglandines. The typical triade of symptoms consisting of flush, diarrhea and cardial complaints leads easily to the diagnosis but is not allways complete. In our patient the examination because of an exophthalmus with conjunctival hyperemia led to the diagnosis.
Case report: History: A 39 year old male patient presented with a red eye, persisting for 18 months. Clinical course: Clinical examination showed a bilateral exophthalmus especially on the right side and conjunctival hyperemia. Magnetic resonance tomography showed bilateral metastases in both inferior rectus muscles. A well differenciated somatostatin-receptor-positive carcinoid was diagnosed in further examinations, with a primary tumour in the upper ileum and metastases in the liver, the orbit and mesenterial lymph nodes.
Therapy: A treatment with somatostatine was necessary to prevent a carcinoid syndrome, before endoscopic laparotomy could be performed. Chemo- and cryotherapy was started.
Conclusion: In exophthalmus with thickening of ocular muscles metastases should be considered. Evaluation in this patient showed a severe oncological disease, which was only apparent for the patient by a reddish eye and protrusion of the globe.
1Eye hospital, 2 Internal medicine II, University of the Saarland, D-66421 Germany