CD56 Negative Extranodal NK/T-cell Lymphoma of the Orbit Mimicking Orbital Cellulitis.

Feb 2013

Pine RR, Clark JD, Sokol JA.

Source

Oculofacial Plastic and Orbital Surgery, KU Eye, University of Kansas , Kansas City, Kansas , USA , and.

Abstract

Introduction: 

To report a case of Extranodal NK/T-cell lymphoma of the orbit mimicking orbital cellulitis. Case Description: A 52-year-old healthy male presented to our institution after 3 months of treatment for sinusitis with antibiotics and steroids. The patient was transferred due to the presence of an "orbital abscess" on CT with orbital signs that not responding to antibiotics. Clinical examination was significant for decreased vision in the affected orbit of 20/50, a trace RAPD OS, elevated IOP of 30 OS, proptosis and grossly decreased motility with diplopia, periorbital edema and chemosis. Dilated funded exam was unremarkable. CT imaging demonstrated a left sided pan-sinusitis, a medial "orbital process" with proptosis and erosion of the cribiform plate. The patient was taken for an emergent orbital exploration for histopathologic diagnosis. Intraorbital and sinus biopsy was consistent with extranodal NK/T-cell lymphoma, with extension into the skull base and left orbital space. The patient was started on radiation therapy followed by chemotherapy. Comments: The authors demonstrate how the acute presentation of an aggressive extranodal NK/T-cell lymphoma can present in a similar fashion as orbital cellulitis. Additionally, the case highlights that a unilateral pansinusitis with involvement of the skull base and orbit is likely due an aggressive malignant process in an immune competent patient.

PubMed

Treatment of Recalcitrant Eosinophilic Cellulitis With Adalimumab

Sept 2012

Kavita Y. Sarin, MD, PhD; David Fiorentino, MD, PhD

Arch Dermatol. 2012;148(9):990-992. doi:10.1001/archdermatol.2012.114

Eosinophilic cellulitis is a rare condition characterized by recurrent pruritic or tender skin lesions. Biopsies usually display characteristic histologic features of dermal edema, eosinophils, and flame figures (collections of degranulated eosinophilic material). Eosinophilic cellulitis typically responds well to systemic steroids. However, oral steroids may be contraindicated in some patients. In addition, long-term use of systemic steroids can lead to steroid dependence as well as adverse effects on bone density, wound healing, and metabolism. Recent evidence in mice suggests that the tumor necrosis factor (TNF) pathway may play a role in antigen-specific IgE production and eosinophil recruitment. This suggests that TNF inhibitors may have some efficacy in the treatment of eosinophilic cellulitis.

Full Text Article with Diagnostic Images:

Archives of Dermatology