Orbital Myositis as an Extraintestinal Manifestation of Crohn's Disease: Case Report
DOI: 10.32364/2587-6821-2026-10-10-6
Orbital Myositis as an Extraintestinal Manifestation of Crohn's Disease: Case Report
А.Yu. Polushin1, V.A. Grachev1, E.I. Lopatina1, E.G. Ganich1, O.V. Sergienya2
1 Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation
2 Almazov National Medical Research Center, St. Petersburg, Russian Federation
Orbital myositis (OM) is a rare extraintestinal manifestation of inflammatory bowel diseases (IBD) that can occur in patients with Crohn's disease and, less commonly, ulcerative colitis. Preceding the onset of symptoms, OM may debut regardless of the IBD activity.
Although systemic glucocorticosteroids (GCS) providing a rapid long-lasting effect are the first-line drugs, GCS-resistant OM with frequent (≤52%) relapses after the therapy withdrawal is reported. The authors present a clinical case report of a female patient with complicated neurological symptoms, Crohn's disease (CD) and recurrent OM. In this case, remission resulted from a combination of mercaptopurine and systemic GCS. Literature data on extraintestinal neurological symptoms of CD are analyzed and presented. Rarity of orbital myositis, unclear pathogenesis, as well as complicated early diagnosis and treatment require a non-standard, multidisciplinary approach involving specialists from various fields.
Keywords: orbital myositis, extraintestinal manifestations, inflammatory bowel diseases, neurological manifestations of Crohn's disease, ulcerative colitis.
For citation: Polushin А.Yu., Grachev V.A., Lopatina E.I., Ganich E.G., Sergienya O.V. Orbital Myositis as an Extraintestinal Manifestation of Crohn's Disease: Case Report. Russian Medical Inquiry. 2026;10(10):–818 (in Russ.). DOI: 10.32364/2587-6821-2026-10-10-6
About the authors:
Alexey Yu. Polushin — C. Sc. (Med.), Assistant Professor, Neurologist, Head of the Scientific and Clinical Center for Transplantation and Cell Therapy in Autoimmune and Neurodegenerative Diseases, Head of the Laboratory of Neuro-Oncology and Autoimmune Diseases, Assistant Professor at the Department of Neurology, Pavlov First Saint-Petersburg State Medical University; 6–8, Lev Tolstoi str., St. Petersburg, 197022, Russian Federation; ORCID iD 0000-0001-8699-2482
Vladimir A. Grachev — Resident at the Department of Neurosurgery, Pavlov First Saint-Petersburg State Medical University; 6–8, Lev Tolstoi str., St. Petersburg, 197022, Russian Federation; ORCID iD 0009-0008-1749-0604
Evgeniya I. Lopatina — Neurologist at the Department of Chemotherapy and Bone Marrow Transplantation in Autoimmune and Neurodegenerative Diseases, Pavlov First Saint-Petersburg State Medical University; 6–8, Lev Tolstoi str., St. Petersburg, 197022, Russian Federation; ORCID iD 0000-0003-1647-1213
Ekaterina G. Ganich — Gastroenterologist, Office of Inflammatory Bowel Diseases, Outpatient Hospital with the Clinical Diagnostic Center, Pavlov First Saint-Petersburg State Medical University; 6–8, Lev Tolstoi str., St. Petersburg, 197022, Russian Federation; ORCID iD 0000-0003-1376-4651
Olga V. Sergienya — C. Sc. (Med.), Radiologist at the MRI Department, Almazov National Medical Research Center; 2, Akkuratov str., St. Petersburg, 197341, Russian Federation; ORCID iD 0000-0002-6495-700X
Contact information: Alexey Polushin, e-mail: alexpolushin@yandex.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 07.10.2025.
Revised 30.10.2025.
Accepted 24.11.2025.
2. Elsehety A., Bertorini T.E. Neurologic and neuropsychiatric complications of Crohn's disease. South Med J. 1997;90(6):606–610. DOI: 10.1097/00007611-199706000-00005
3. Lossos A., River Y., Eliakim A. et al. Neurologic aspects of inflammatory bowel disease. Neurology. 1995;45(3 Pt 1):416–421. DOI: 10.1212/wnl.45.3.416
4. Ståhlberg D., Bárány F., Einarsson K. et al. Neurophysiologic studies of patients with Crohn's disease on long-term treatment with metronidazole. Scand J Gastroenterol. 1991;26(2):219–224. DOI: 10.3109/00365529109025034
5. Goolsby T.A., Jakeman B., Gaynes R.P. Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents. 2018;51(3):319–325. DOI: 10.1016/j.ijantimicag.2017.08.033
6. Fromont A., De Seze J., Fleury M.C. et al. Inflammatory demyelinating events following treatment with anti-tumor necrosis factor. Cytokine. 2009;45(2):55–57. DOI: 10.1016/j.cyto.2008.11.002
7. Lozeron P., Denier C., Lacroix C. et al. Long-term course of demyelinating neuropathies occurring during tumor necrosis factor-alpha-blocker therapy. Arch Neurol. 2009;66(4):490–497. DOI: 10.1001/archneurol.2009.11
8. Thomas C.W. Jr., Weinshenker B.G., Sandborn W.J. Demyelination during anti-tumor necrosis factor alpha therapy with infliximab for Crohn's disease. Inflamm Bowel Dis. 2004;10(1):28–31. DOI: 10.1097/00054725-200401000-00004
9. Kaltsonoudis E., Voulgari P.V., Konitsiotis S. et al. Demyelination and other neurological adverse events after anti-TNF therapy. Autoimmun Rev. 2014;13(1):54–58. DOI: 10.1016/j.autrev.2013.09.002
10. Hedin C.R.H., Vavricka S.R., Stagg A.J. et al. The Pathogenesis of Extraintestinal Manifestations: Implications for IBD Research, Diagnosis, and Therapy. J Crohns Colitis. 2019;13(5):541–554. DOI: 10.1093/jchcol/jty187
11. Hernández-Garfella M.L., Gracia-García A., Cervera-Taulet E. et al. Adalimumab for recurrent orbital myositis in Crohn's disease: report of a case with a 3-year follow-up. J Crohns Colitis. 2011;5(3):265–266. DOI: 10.1016/j.crohns.2011.02.010
12. Kondolot M., Unal E., Poyrazoglu G., Kara A. et al. Orbital myositis associated with focal active colitis in a teenage girl. Childs Nerv Syst. 2012;28(4):641–643. DOI: 10.1007/s00381-011-1613-8
13. Mc Clelland C., Zaveri M., Walsh R. et al. Optic perineuritis as the presenting feature of Crohn disease. J Neuroophthalmol. 2012;32(4):345–347. DOI: 10.1097/WNO.0b013e31825e8e2e
14. Katsanos A., Asproudis I., Katsanos K.H. et al. Orbital and optic nerve complications of inflammatory bowel disease. J Crohns Colitis. 2013;7(9):683–693. DOI: 10.1016/j.crohns.2012.09.020
15. Braithwaite T., Subramanian A., Petzold A. et al. Trends in optic neuritis incidence and prevalence in the UK and association with systemic and neurologic disease. JAMA Neurol. 2020;77(12):1514–1523. DOI: 10.1001/jamaneurol.2020.3502
16. Karmody C.S., Valdez T.A., Desai U. et al. Sensorineural hearing loss in patients with inflammatory bowel disease. Am J Otolaryngol. 2009;30(3):166–170. DOI: 10.1016/j.amjoto.2008.04.009
17. Белоусова Е.А., Шелыгин Ю.А., Ачкасов С.И. и др. Клинико-демографические характеристики и лечебные подходы у пациентов с воспалительными заболеваниями кишечника (болезнь Крона, язвенный колит) в РФ. Первые результаты анализа национального Регистра. Колопроктология. 2023;22(1):65–82. DOI: 10.33878/2073-7556-2023-22-1-65-82 . Belousova E.A., Shelygin Yu.A., Achkasov S.I. et al. Clinical and Demographic Features and Treatment Approaches for Inflammatory Bowel Diseases (Crohn's Disease, Ulcerative Colitis) in the Russia. The Primery Results of the Analysis of the National Register. Koloproktologia. 2023;22(1):65-82 (in Russ.). DOI: 10.33878/2073-7556-2023-22-1-65-82
18. Glover K., Mishra D., Singh T.R.R. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol. 2021;12:744396. DOI: 10.3389/fimmu.2021.744396
19. Скворцова Т.А., Кильдиярова Р.Р., Теликова С.В. и др. Агрессивный вариант течения болезни Крона у девочки-подростка (клинический случай). Доказательная гастроэнтерология. 2024;13(1):115–120. DOI: 10.17116/dokgastro202413011115. Skvortsova T.A., Kildiyarova R.R., Telikova S.V. et al. Aggressive course of Crohn's disease in an adolescent girl (clinical case). Evidence-Based Gastroenterology. 2024;13(1):115–120 (in Russ.). DOI: 10.17116/dokgastro202413011115
20. Vargason C.W., Mawn L.A. Orbital Myositis as Both a Presenting and Associated Extraintestinal Sign of Crohn's Disease. Ophthalmic Plast Reconstr Surg. 2017;33(3S):S158–S160. DOI: 10.1097/IOP.0000000000000475
21. Papadopoulou M., Tzortsou S., Chatzi I. et al. Oculomotor nerve palsy as an extraintestinal manifestation of Crohn's disease. BMJ Case Reports. 2023;16(5):e254456. DOI: 10.1136/bcr-2022-254456
22. Sandhu S., Wang T., Donet J.A. Orbital Myositis in a Patient With Ileal Crohn's Disease in Remission on Vedolizumab. ACG Case Rep J. 2022;9(5):e00775. DOI: 10.14309/crj.0000000000000775
23. Hoilat G.J., Subedi A., Ayas M.F. et al. Keep an Eye Out for Crohn's Disease: Orbital Myositis as the Initial Sign before Gastrointestinal Manifestations. Eur J Case Rep Intern Med. 2020;7(12):001964. DOI: 10.12890/2020_001964
24. Akhrieva Kh.M., Zayrat'yants O.V., Tertychnyy A.S. Features of Granulematous Inflammation in Crohn's Disease. J Anat Histopathol. 2017;6(2):101–107. DOI: 10.18499/2225-7357-2017-6-2-101-107
25. Taleban S., Li D., Targan S.R. et al. Ocular Manifestations in Inflammatory Bowel Disease Are Associated with Other Extra-intestinal Manifestations, Gender, and Genes Implicated in Other Immune-related Traits. J Crohns Colitis. 2016;10(1):43–49. DOI: 10.1093/ecco-jcc/jjv178
26. Harbord M., Annese V., Vavricka S.R. et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2016;10(3):239–254. DOI: 10.1093/ecco-jcc/jjv213
27. Verma S., Kroeker K.I., Fedorak R.N. Adalimumab for orbital myositis in a patient with Crohn's disease who discontinued infliximab: a case report and review of the literature. BMC Gastroenterol. 2013;13:59. DOI: 10.1186/1471-230X-13-59
28. Adams D.H., Eksteen B. Aberrant homing of mucosal T cells and extra-intestinal manifestations of inflammatory bowel disease. Nat Rev Immunol. 2006;6(3):244–251. DOI: 10.1038/nri1784
29. Breban M., Tap J., Leboime A. et al. Faecal microbiota study reveals specific dysbiosis in spondyloarthritis. Ann Rheum Dis. 2017;76(9):1614–1622. DOI: 10.1136/annrheumdis-2016-211064
30. Van Sommeren S., Janse M., Karjalainen J. et al. Extraintestinal manifestations and complications in inflammatory bowel disease: from shared genetics to shared biological pathways. Inflamm Bowel Dis. 2014;20(6):987–994. DOI: 10.1097/MIB.0000000000000032
31. Ball C.M., Phillips R.S. Evidence-Based On-Call Acute Medicine. Edinburgh: Churchill Livingstone; 2001.
32. Migliorisi G., Vella G., Dal Buono A. et al. Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It. Cells. 2024;13(2):142. DOI: 10.3390/cells13020142
33. Кузнецова Д.А., Лапин С.В., Щукина О.Б. Диагностическая и прогностическая значимость серологических маркеров воспалительных заболеваний кишечника (обзор литературы). Альманах клинической медицины. 2020;48(6):364–742. DOI: 10.18706/0368-4814.2020.48.6.364-742. Kuznetsova D.A., Lapin S.V., Shchukina O.B. The diagnostic and prognostic value of serological markers of inflammatory bowel diseases (a literature review). Almanac of Clinical Medicine. 2020;48(6):364–742 (in Russ.). DOI: 10.18706/0368-4814.2020.48.6.364-742
34. Rodriguez Duran M., O'Keefe G.A.D. Ocular extraintestinal manifestations and treatments in patients with inflammatory bowel disease. Front Ophthalmol (Lausanne). 2024;3:1257068. DOI: 10.3389/fopht.2023.1257068
35. Gondim F.A., Brannagan T.H., Sander H.W. et al. Peripheral neuropathy in patients with inflammatory bowel disease. Brain. 2005;128(4):867–879. DOI: 10.1093/brain/awh429
36. Warendorf J., Vrancken A.F., Van Schaik I.N. et al. Drug therapy for chronic idiopathic axonal polyneuropathy. Cochrane Database Syst Rev. 2017;6:CD003456. DOI: 10.1002/14651858.CD003456.pub3
This work is licensed under a Creative Commons «Attribution» 4.0 License.
