DR. KIRTHI KOKA

Abstract

A 58 year old lady presented with complaints of bilateral periorbital swelling and redness for the past 5 months.On examination she had bilateral diffuse, firm, tender periorbital erythematous swellings and conjunctival congestion giving a salmon patch appearance.Previous CT images showed isodense lesion enveloping the globe suggestive of lymphoma.MRI showed bilateral ill-defined soft tissue with asymmetrical enlargement of the extraocular muscles with no restricted diffusion.Incisional biopsy and histopathology was suggestive of xanthogranuloma.Immunohistochemisty showed CD 68 positivity, confirming diagnosis.She developed multiple erythematous lesions over her forearms and legs.Bone marrow biopsy and serum electrophoresis were normal. She was started on tapering dose oral steroids. Xanthogranuloma though rare should be considered as a differential for bilateral periorbital swelling. Systemic evaluation is mandatory to rule out multisystem involvement and hematological malignancies.