Abstract

P 247

Masquerade syndrome: Non-Hodgkin B-cell lymphoma as an infectious painful dacryocystitis in a 15-year-old boy

Wali U. K.¹, Bialasiewicz A. A.¹, Ganesh A.¹, Tanyous G.², Date A.^3
1Department of Ophthalmology and School of Ophthalmic Technicians, ²Department of Ear Nose Throat Diseaess, ³Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman

Objective: To report on a case of non-Hodgkin lymphoma masquerading as infectious dacryocystitis.
Methods: A 15-year-old male Omani boy (MSMM) presented with a painful swelling and purulent exudate of his left lower eyelid and medial canthus since 3 weeks, and which had been treated unsuccessfully with local antibiotics. Vision was not affected OU 1.0, motility was free. An initial diagnosis of dacryocystitis resulted in antibiotic treatment with intravenous meropenem. A microbiology swab from the ulcer did not reveal any growth of pathogenic organisms. After 2 days, no amelioration of the signs was noted, however, on the 3^rd day the patient complained about a fleshy mass on his palate.
Results: A CCT scan revealed a soft tissue mass in the left maxillary sinus with extension into the left nasal cavity, orbit and lower eyelid. HIV serology was negative. A biopsy of the maxillary sinus was performed, histopathology revealed a Non-Hodgkin B-cell lympho­ma. Work-up for C.psittaci infection was negative. A CHOP therapy was initiated, and the antibiotic treatment was stopped. The “dacryocystitis” resolved completely, as well as the other tumor masses. Until now, the boy is in remission for 3 years.
Conclusions: Treatment-resistant fleshy masses in the lacrimal duct system with “purulent” discharge and dacryocystitis-like inflammation, pain and swelling in young patients may masquerade a Non-Hodgkin lymphoma.

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