PMC7334781_01
Acupuncture trigger points and sites of granuloma formation. Granulomas were found at sites labelled (a)-(f), which correspond to common acupuncture trigger points: (a) jingming, (b) tongziliao, (c, d) taiyang, (e) bitong, and (f) quanliao.
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fig1
On exam, the patient was found to have multiple nontender, nonpigmented nodules without overlying skin changes at the following locations: below the left medial canthal tendon measuring 1 cm (Figure 1(a)), below the left lateral canthal tendon measuring 0.5 cm (Figure 1(b)), and lateral to the left eyebrow measuring 0.75 cm (Figure 1(c)). The patient subsequently underwent excisional biopsy of both canthal lesions (Figures 1(a) and 1(b)). Given the additional exposure history, the patient was reexamined, and additional nodules along the right brow (Figure 1(d)), right nasolabial groove (Figure 1(e)), and left canine fossa (Figure 1(f)) were found, which corresponded to trigger points commonly used in acupuncture.
Histopathology of periorbital granuloma (400x magnification). (a) Hematoxylin and eosin stain demonstrate noncaseating granuloma with multiple foci of clear vacuole-like spaces containing silicone. No organisms were seen on (b) gram, (c) GMS, and (d) acid-fast stains.
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Hematoxylin and eosin stain of the two excised specimens revealed fibrovascular tissue containing granulomatous inflammation with foci of clear spaces consistent with silicone oil or other foreign material (Figure 2(a)). No organisms were seen on gram stain, Grocott's methenamine silver stain, or acid-fast staining (Figures 2(b)-2(d)).