Bisphosphonate-Induced Acute Orbital Inflammation in a Patient With Underlying Thyroid Ophthalmopathy

Abstract

Bisphosphonates are widely used for various conditions, including osteoporosis, hypercalcemia of malignancy, osteolytic bone metastasis, and Paget's disease. Bisphosphonate-induced orbital inflammation is a rare side effect of amino-bisphosphonates. There has been less focus on the risk of developing amino-bisphosphonate-induced orbitopathy in people who have underlying ophthalmopathy. Herein, we present a case of alendronate-induced acute orbital inflammation in a patient with underlying Graves' ophthalmopathy. Soon after administration of intravenous (IV) dexamethasone with topical prednisolone, the inflammation rapidly resolved. To our knowledge, this is the first case of bisphosphonate-induced orbital inflammation with underlying orbitopathy. This case demonstrates that systemic corticosteroids can be an effective treatment in orbital inflammation in similar cases. There is a possible interaction of T-cell and cytokine involvement mechanisms between Graves' orbitopathy and bisphosphonate-induced orbital inflammation. This case also shows that bisphosphonate-induced acute orbital inflammation is rare but should be part of a physician's differential diagnosis, and more precautions are necessary for patients with underlying orbitopathy who are taking bisphosphonates.