Treatment of recurrent eosinophilic granuloma with systemic therapy

Alice Song, Thomas E. Johnson, Sander R. Dubovy, Stuart Toledano

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Purpose: To describe the systemic treatment of recurrent eosinophilic granuloma. Methods: Case report and review of Langerhans cell histiocytosis. Results: A 9-year-old boy had painful, right upper eyelid swelling. A computed tomography scan showed a right superolateral orbital mass with evidence of bony erosion. Frozen section evaluation was consistent with eosinophilic granuloma. Biopsy and curettage were performed. Systemic work-up was negative for extraorbital disease. Recurrence of the orbital mass 6 weeks after surgery was confirmed by magnetic resonance imaging (MRI). Four weeks after treatment with prednisone and vinblastine, MRI showed a marked decrease in the size of the orbital lesion. Additional treatment with 6-mercaptopurine and methotrexate was initiated, and MRI 6 months later showed complete resolution of the lesion. Conclusions: The treatment of recurrent eosinophilic granuloma is challenging. The goal is to effectively cure the lesion with minimal short-term and long-term side effects. Systemic steroids, vinca alkaloids, antimetabolites, and antifols are preferred because they have less toxicity and mutagenicity. Combination chemotherapy used in conjunction with treatment by a pediatric hematologist/oncologist appears to be an effective method of treating recurrent disease.

Original languageEnglish (US)
Pages (from-to)140-144
Number of pages5
JournalOphthalmic plastic and reconstructive surgery
Volume19
Issue number2
DOIs
StatePublished - Mar 1 2003

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology

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