Periocular granuloma annulare in four children

Periocular subcutaneous granuloma annulare in a child: A case report

Purpose

We describe a rare case of annular granuloma involving the eyelid of a child, a 6-year-old male, who presented with multiple subcutaneous nodular lesions involving the upper eyelid of the right eye.

Observations

The slit-lamp examination of the eye was normal. Extra-ocular examination showed a lesion on the dorsal aspect of the right foot, which was resistant to treatment with topical corticosteroids. He underwent surgical excision of the eyelid nodules under general anesthesia. Histopathology with immunohistochemical staining of the excisional biopsy confirmed the diagnosis of annular granuloma, with positive Vimentin and CD68 stains in many palisading histiocytic cells, while Factor VIIIa, S100, and CD1a were negative. Tuberculosis was ruled out by negative Ziehl-Neelsen staining for acid-fast bacilli.

Conclusions and importance

This idiopathic granulomatous condition proved to be a benign, self-limiting cutaneous disease that can regress spontaneously. It affects the skin of the foot in more than 70% of all patients; however, involvement of the eyelid is extremely rare. We report this case to highlight such a rare entity and increase awareness regarding this dermatological condition among ophthalmologists.

Presumed Choroidal Granuloma Annulare Mimicking Choroidal Lymphoma

A 71-year-old white male presented with unilateral trace vitreous cell and hypopigmented choroidal lesions, corresponding to hyporeflective areas on optical coherence tomography (OCT). The lesions grew slowly during a period of 2.5 years, but the patient remained asymptomatic. Cutaneous biopsy from the left forearm confirmed granuloma annulare. Given an otherwise unrevealing workup for infectious, inflammatory, and neoplastic processes, the choroidal lesions were considered to be a manifestation of the same disease process. Treatment consisted of posterior sub-Tenon's triamcinolone. After 6 weeks, the lesions appeared atrophic on funduscopy with resolution on OCT. Examination remained stable with no growth or recurrence after 4 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e128-e132.].

Periocular dermatoses

The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.

Intraorbital granuloma annulare in an elderly patient

Classically, granuloma annulare (GA) is a cutaneous disorder localized to the dorsum of the hands and/or feet in children and young adults. Very rarely it can present on the face and rarer still on periorbital structures such as the eyelid and orbital rim. Diagnosis hinges on clinical presentation and histological features, such as palisading granulomas with central destruction of collagen, presence of mucin and lymphohistiocytic infiltration. The etiology of this condition remains unknown, but may involve a delayed-type hypersensitivity reaction, malignancy and/or infection. Herein is the first reported case of an intraorbital GA in an 86-year-old male patient who presented with right eye proptosis.

Periocular granuloma annulare: a case report and review of literature

Granuloma annulare (GA) is a granulomatous dermatosis that rarely presents on the face and is extremely uncommon in the periocular region. We report our experience with the presentation and management of GA lesions on the eyelids of a 17-year-old girl. We performed a review of published literature and identified 13 cases of pediatric periocular GA. One additional case was identified upon review of all pediatric GA cases at the Cleveland Clinic Foundation. Review of these cases suggests that periocular GA is a benign condition that spontaneously regresses within a few months. GA nodules have a predilection for the upper eyelids. A greater incidence is noted in African American children. Awareness of the self-resolving nature of this condition can prevent unnecessary surgical excisions in affected children.