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Patient History

Mr. G.R. is a 20-year-old man with no significant past medical history. He presented in July of 2013 with two months of worsening pain over the right orbit. Periorbital edema was also present. Initial treatment with eye drops, antibiotics (erythromycin followed by cephalexin), and steroids (prednisone) failed to control his symptoms.

In October of 2013, CT and MRI scans revealed a permeative destructive lesion centered in the right orbital roof with extension into the superior orbit and the floor of the anterior cranial fossa. There was no abnormal enhancement in the visualized brain parenchyma.

The radiologic appearance of the mass suggested a differential diagnosis of a lymphoma, a metastasis, an eosinophilic histiocytosis, or an infection.

In November of 2013, the patient underwent a frontal craniotomy for resection of a 2.4 cm mass in the orbital rim. Langerhans cell histiocytosis was diagnosed by frozen section and confirmed by immunohistochemistry.

In December of 2013, the patient was seen for surgical follow-up at which time his pain, swelling, and erythema had completely resolved. There were no visual abnormalities present.