PMC4042138_01
Examination results of case 1. (A) Face photograph of case 1 showing fullness along the lateral orbital rim with ptosis especially laterally (arrow). (B) External photograph showing sites of abscess drainage (scars) in the supraclavicular region and arm (arrows). (C) Computed tomography scan of the orbits showing lytic lesion in the bone with sequestration. (D) Photograph showing the pus collected and the chronic granulomatous inflammation on histopathology showing caseation necrosis.
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F1
On examination, fullness along the left lateral orbital rim with ptosis (especially laterally) and limitation of abduction in the left eye were noted (Figure 1A). Systemic examination revealed scars in the supraclavicular region and arm (Figure 1B). Computed tomography (CT) of the orbits revealed a well-defined lytic lesion along the lateral orbital wall with central sequestrum and associated peripherally enhancing abscess with minimal periosteal reaction suggestive of osteomyelitis (Figure 1C). Chronic granulomatous inflammation with caseation necrosis was seen on histopathology (Figure 1D).
PMC4042138_02
Examination results of case 2. (A) Face photograph of case 2 showing fullness below the lateral part of the left eye brow in the lacrimal gland area (arrow). (B) CT scan showing diffuse enlargement of the lacrimal gland, without bony erosion or bony remodelling. (C) Photomicrograph showing granulomatous inflammation with caseation necrosis (arrow).
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F2
Examination revealed a firm, palpable mass in the region of the lacrimal gland (Figure 2A). CT scan showed diffuse enlargement of the lacrimal gland with no bony remodelling or moulding around the globe (Figure 2B). The excised mass showed granulomatous inflammation with caseation necrosis on histopathology (Figure 2C).
PMC4042138_03
Examination results of case 3. (A) Face photograph of case 3 showing fullness below the lateral part of the right eye brow. (B) CT scan showing diffuse enlargement of the lacrimal gland (arrows) without any bony erosion or remodelling. (C) Microphotograph showing the chronic granulomatous inflammation with giant cells (arrow) and caseation necrosis (H&E).
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F3
Examination revealed a diffuse, non-tender, firm mass in the lacrimal gland area (Figure 3A). CT scan showed diffuse enlargement of the lacrimal gland with no bony erosion or remodelling (Figure 3B). Excision biopsy showed granulomatous inflammation with caseation necrosis on histopathology (Figure 3C).
PMC4042138_04
Examination results of case 4. (A) Face photograph of case 4 showing an indurated mass lesion with an overlying non-healing ulcer with discharge in the lacrimal sac area of the right eye (arrow). (B) CT scan showing soft tissue lesion in the anterior part of right medial orbit (arrow). (C) Photomicrograph showing chronic granulomatous inflammation with giant cells (arrow).
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F4
A 39-year-old lady was referred to our center for an indurated mass lesion with an overlying non-healing ulcer in the medial part of the right lower lid of 3 months duration (Figure 4A). CT scan of the orbits showed a soft tissue lesion in the anterior part of right medial orbit, and the lacrimal sac could not be delineated separately from the mass (Figure 4B). Histopathological examination of the abscess wall showed granulomatous inflammation with caseation (Figure 4C).
PMC4042138_05
Examination results of case 5. (A) Face photograph of case 5 showing a preseptal swelling below the left superior orbital rim (arrow). (B) CT scan of the orbits showing soft tissue swelling in front of the superior orbital rim with no evidence of bony erosion (arrow). (C) Photomicrograph showing chronic granulomatous inflammation with giant cells and caseation necrosis (arrow).
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F5
On examination, a firm, non-tender mass could be palpated in the inferior portion of the superior orbital rim (Figure 5A). CT scan orbits showed a soft tissue swelling inseparable from the left orbital rim (Figure 5B). Excision biopsy of this lesion revealed granulomatous inflammation with caseation (Figure 5C).
PMC4042138_06
Examination results of case 6. (A) Face photograph of case 6 showing large ulceration on the right cheek below the right lower eyelid. Microphotograph showing (B) chronic granulomatous inflammation with giant cells and caseation necrosis and (C) positive acid fast bacilli indicated by an arrow.
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F6
On examination, she had a large non-healing ulcer on the right lower eyelid (Figure 6A). Histopathological examination of the excised ulcer tissue showed a granulomatous inflammation with giant cells and caseation (Figure 6B). ZN stain for AFB was positive (Figure 6C), while GMS stain for fungi was negative.