Eyelid molluscum contagiosum presenting as a giant solitary ulcerating mass

Molluscum contagiosum is a benign viral cutaneous infection. It typically presents as an asymptomatic centrally umbilicated nodule 3–5?mm in diameter. Susceptible patients are children and adults receiving immunosuppressive therapy. We report a case of an eyelid molluscum contagiosum in a 5-year-old boy with no risk factors and a 2-week history of a large localized ulcerating mass of the left upper eyelid. The mass was totally excised, and diagnosis of molluscum contagiosum was confirmed in the histopathology study. Microscopic examination revealed enlarged keratinocytes, and acquired eosinophilic Henderson-Patterson inclusion bodies were also detected. Such ulcerating solitary lesions can be misdiagnosed as infected epidermal cysts, keratoacanthoma, or infected chalazions; therefore, molluscum contagiosum should be considered in the differential diagnosis. Complete excisional biopsy of the mass is diagnostic and curative.     

Proptosis as a presenting sign of extradural haematoma.

A conscious 15-year-old boy presented with progressive proptosis and a severe headache 2 weeks after minor blunt trauma to the head. No neurological deficit was present. Computed tomography demonstrated intracranial and intraorbital cyst-like masses. At craniotomy a subacute extradural haematoma was found which communicated with an orbital subperiosteal haematoma through a shelved orbital roof fracture. The haematomas were drained and the patient made an uneventful postoperative recovery. Although rare, an extradural haemorrhage should be considered in any patient presenting to an ophthalmologist with progressive proptosis and headache following a head injury.     

Acute dacryocystitis as a presenting sign of pediatric leukemia

PURPOSE: To report acute dacryocystitis with preseptal cellulitis as the presenting sign of leukemia in a child. METHODS: Case report and literature review. RESULTS: During the initial evaluation of a 17-month-old child with epiphora, left lower eyelid swelling, and a tender left medial canthal mass, a complete blood cell count demonstrated pancytopenia. Bone marrow biopsy disclosed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. DNA analysis disclosed a translocation between chromosome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous antibiotics, lacrimal sac distention decreased only after chemotherapy was initiated. CONCLUSIONS: Dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation.     

Radial keratoneuritis as a presenting sign in Acanthamoeba keratitis

Three myopic patients who wore soft contact lenses developed unilateral Acanthamoeba keratitis that presented with unusual infiltrates that appeared to be located along the corneal nerves. These infiltrates were found in the midstroma, beginning paracentrally, and extending to the limbus in a radial pattern. The epithelium overlying these infiltrates was intact. In two patients, the central epithelium had a stippled, almost dendritiform appearance leading to the misdiagnosis of herpes simplex keratitis. Cultures from corneal scrapings of two patients and cultures of a corneal biopsy from one patient, which included an area of presumed neural involvement, grew Acanthamoebae. All three patients used homemade saline solutions (salt tablets dissolved in distilled water). In one patient, Acanthamoebae were found in the contact lens case solution. In our recent experience, Acanthamoebae have also been found in the distilled water bottle and the saline solution made from distilled water and salt tablets in two additional patients with A. keratitis. Distilled water, which is not sterile, has proven to be one potentially avoidable source of A. keratitis in contact lens wearers.     

Advanced xerophthalmia as a presenting sign in cystic fibrosis

Xerophthalmia is a common complication of vitamin A deficiency in communities where malnutrition is found. We report on a 16-month-old infant with severe photophobia and failure to thrive. On examination, her major presenting sign was corneal xerosis, with corneal and conjunctival keratinization, and corneal stromal edema with opacification. Based on these findings, vitamin A deficiency secondary to fat malabsorption was suspected, and a workup confirmed the diagnosis of cystic fibrosis. With parenteral vitamin A supplementation, she had complete resolution of her ocular signs and symptoms. This case illustrates the value of a complete ophthalmic examination in the diagnosis of fat malabsorption syndromes.     

Panuveitis as presenting sign of chickenpox in a young child

CASE REPORT: A previously healthy 2-year-old girl presented with severe panuveitis in her left eye. She developed chickenpox rash several days later. DNA particles of varicella-zoster virus (VZV) were detected by polymerase chain reaction (PCR) in the aqueous humor. No antiviral regimen was administered. The uveitis resolved completely after 1 week. COMMENTS: Patients with chickenpox should undergo a thorough ophthalmologic examination at the onset of visual symptoms. Clinicians should be aware of the rare occurrence of chickenpox when evaluating a uveitis patient. If there is suspicion of chickenpox, the clinician may consider ordering serology or PCR tests.     

Crystalline keratopathy as a presenting sign of multiple myeloma]

BACKGROUND: Noninfectious crystalline corneal degenerations can be classified from the clinical and genetical point of view into 3 groups: 1. primary hereditary (Schnyder), 2. secondary hereditary (cystinosis) and 3. secondary non-hereditary in association with disorders of serum protein or lipid composition. PATIENT: We report on a 63-year-old man with reduced vision and grey-white, crystalline, monomorpheous deposits in the corneal stroma. Further investigation revealed IgG myeloma. RESULTS: We performed a penetrating keratoplasty for visual improvement. On histopathological examination, typical eosinophilic, PAS-positive, interlamellar deposits staining brilliant red with Masson's trichrome were found diffusely scattered throughout the stroma. Electron microscopy showed intracellular, rhomboid-shaped deposits enveloped by a membrane. CONCLUSION: The appearance of a crystalline keratopathy should be followed by an internal examination for early detection and adequate treatment of a systemic disease.     

Epiphora as a presenting sign of angioleiomyoma of the lacrimal sac

A 50-year-old man presented with progressive enlargement of a right medial canthal mass for 5 years. The patient subsequently noted epiphora of 6-month duration on the affected side. An anterior orbitotomy was performed, which uncovered a well-circumscribed mass in the lacrimal sac. Histologic sections of the mass revealed an angioleiomyoma. Following complete excision, the epiphora resolved and there is no evidence of tumor recurrence at 1 year of follow-up. To the best of our knowledge, this is the first report of an angioleiomyoma in the lacrimal sac.     

Orbital tumor as a presenting symptom of occult carcinoma of the thyroid

A rare case of thyroid carcinoma presenting as an orbital tumor is described. The diagnosis was made only through histopathologic examination of tissues removed during craniotomy. Thyroid scan confirmed the diagnosis. Thyroid carcinoma should be suspected in cases of orbital metastasis of unknown origin.     

Peripheral nonulcerative keratitis as a presenting sign of microscopic polyangiitis.

PURPOSE: To report a 16-year-old woman who had peripheral keratitis as a presenting sign of microscopic polyangiitis (MPA), which rapidly progressed to acute renal failure. METHOD: Case report. RESULTS: The patient's vasculitis was diagnosed by renal biopsy, which was evaluated with histologic, immunofluorescence, and electron microscopy. The diagnosis was confirmed by laboratory study, which showed a positive antimyeloperoxidase antibody. CONCLUSION: MPA may rarely present with ocular findings and should be considered in the differential diagnosis when a patient has peripheral keratitis.