A 32-year-old man with colon neoplasia with hepatic, retroperitoneal and mediastinal metastases, with a rapid evolution on a background of ulcerative colitis.
A week after diagnosis, despite presenting an advanced stage, he was admitted for surgery with partial tumour resection, and postoperative chemotherapy treatment was started with different consecutive lines of therapy: oxaliplatin+folinic acid+fluorouracil, capecitabine+oxaliplatin, and capecitabine+irinotecan, with no response. The K-ras gene was even determined for possible treatment with cetuximab or panitumumab, which was negative and therefore ruled out this therapeutic alternative. Furthermore, treatment with bevacizumab was not advisable as the patient presented with drainage in the abdominal cavity, with production of purulent material.
Fifteen days after surgery, the patient reported moderate pain in the left eye, for which reason he requested a consultation with our department. On ophthalmological examination, the patient presented moderate eyelid oedema, conjunctival chemosis, severe non-reducible exophthalmos, complete ptosis in the left eye, and limited ocular motility in all gaze positions, but especially in lateral gaze and supraversion.
Cranial and orbital magnetic resonance imaging (MRI) was requested, with T1-weighted images and axial diffusion-weighted and FLAIR images. Two nodular lesions were observed in the left orbit, one of them measuring 2×1cm, located in the superior region, with involvement of the superior rectus and levator muscles; and the second, located at the level of the apex, with involvement of the external rectus, all highly suggestive of metastasis of the extrinsic ocular musculature.
Due to the patient's poor general condition, palliative radiotherapy was ruled out, and methylprednisolone boluses were started at a dose of 1g/day, with partial relief of pain. However, 48 hours after the second bolus of corticotherapy, the patient presented extreme abdominal and ocular pain, so palliative sedation was decided, and the patient died.
