Bilateral Extraocular Muscle Metastases in Zollinger-Ellison Syndrome

In Zollinger-Ellison syndrome, gastric, duodenal, and jejunal ulcers are associated with gastrinsecreting non-β-islet cell tumors of the pancreas (gastrinomas).1The tumors may arise in multiple sites (multifocal endocrine neoplasia type I),1and gastrinomas may metastasize to lymph nodes, liver, thorax, skin, or bone. We report herein a unique case of bilateral ocular muscle metastases. Report of a Case. A 40-year-old woman complained of acute right eyelid swelling and diplopia following 2 months of right retro-orbital pain. She had experienced episodes of diarrhea, vomiting, and chest and back pain at age 33 years. An upper gastrointestinal tract series documented multiple gastric and duodenal ulcers for which treatment with histamine (H2blockers and sucralfate (Carafate) was begun. At age 37 years, the patient underwent computed tomography of the abdomen, which demonstrated low-attenuation hepatic lesions; these findings and an elevated serum gastrin level prompted a truncal vagotomy, Whipple procedure (pancreatoduodenectomy),