Langerhans cell histiocytosis mimicking hematoma of the lower eyelid: A case report.

RATIONALE

The orbital Langerhans cell histiocytosis (LCH) is rare clinically, due to its ability to mimic other conditions, distinguishing LCH from hematoma when these disorders coexist can be particularly challenging.

PATIENT CONCERNS

A 3-year-old boy presented with a 2-week history of unresolved bruising and swelling of the left eye. CT revealed a well-defined cystic lesion in the preseptal tissues of the left eyelid, with an incomplete bone structure at the lower margin of the orbit. MRI revealed a well-circumscribed circular mass in the lower margin of the orbit, and a second lesion under the hematoma.

DIAGNOSIS

Postoperative histological examination revealed a diagnosis of LCH with concurrent hematoma.

INTERVENTIONS

The lesions in the left eye were surgically removed through a lower eyelid skin incision under general anesthesia. The patient received 6 courses of systemic chemotherapy, consisting of a combination of vinblastine and prednisolone.

OUTCOMES

No recurrence was observed after a follow-up period of 11 months.

LESSONS

LCH rarely occurs at the infraorbital margin. When external factors, lead to local bleeding and hematoma formation, the presence of lesions may be masked, resulting in a missed diagnosis. Radiographic features such as localized "worm-eaten" bone destruction should not be overlooked for timely LCH diagnosis and treatment.