Successful treatment of refractory focal eosinophilic myositis with extra-ocular muscle involvement using tocilizumab: a case report

By
Haijun Liu
Qianhua Li
Xia Ouyang
Shuyu Chen
Henglun Liang
Yufeng Ye
Huiyuan Cao
Yong Xue
Lie Dai
May 25, 2026

Frontiers In Immunology

Overview

This case study presents a 65-year-old woman with refractory focal eosinophilic myositis (FEM) involving extra-ocular muscles. Treatment with tocilizumab resulted in significant clinical improvement after conventional therapies failed.

Background

Eosinophilic myositis (EM) is a rare inflammatory myopathy characterized by eosinophilic infiltration of muscle tissue. Focal eosinophilic myositis (FEM) typically affects the limbs, but extra-ocular muscle involvement is exceedingly rare and poorly documented. Understanding treatment responses in such cases is crucial for developing effective management strategies.

Data Highlights

No numerical data or trial data available in the source material.

Key Findings

A 65-year-old woman presented with multifocal FEM and extra-ocular muscle involvement.
Initial treatment with prednisone and immunosuppressants led to regression of truncal lesions.
Relapse occurred during glucocorticoid tapering, specifically affecting the left extra-ocular muscles.
Tocilizumab treatment resulted in gradual improvement in ocular symptoms and muscle swelling.
This case highlights a potentially treatment-resistant phenotype of FEM with extra-ocular muscle involvement.

Clinical Implications

The case suggests that extra-ocular muscle involvement in FEM may require alternative therapeutic approaches. Tocilizumab may be a viable option for patients who do not respond to conventional immunosuppressive therapies.

Conclusion

This case underscores the complexity of managing refractory FEM, particularly with extra-ocular muscle involvement, and the potential role of tocilizumab as a therapeutic option.