Title: A Rare Unusual Facial Swelling
Authors: Dr Kush Jhunjhunwala, MD (Paed), DNB (Paed), Dr Gurmeet Singh Sarla, MS (Gen Surg)
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.69
Abstract
Introduction
We report and discuss a case of unusual eosinophilic epithelioid granulomatous reaction. 13 years old male resident of Bihar, India was admitted with history of swelling left side of the face since 2 months, fever and swelling around right eye since1month.
There was no history of ear discharge/ache, difficulty in mastication, excessive weight loss, chronic cough, discharging sinus and bony tenderness. No history of Joint pain/swelling, decrease visual acuity/dry eyes, testicular enlargement, tuberculosis contact, bleeding, blood transfusion. At the time of admission, vitals were temperature 102.6°F, Heart rate 100/min, Respiratory rate 30/min, Blood pressure 100/62mmHg. On general examination, no pallor, icterus, clubbing, pedal edema, petechiae. Left Axillary lymph node was 1.5 cms, soft, tender, mobile, overlying skin normal. On local examination there was a diffuse swelling over left parotid region extending up to submandibular region, firm, regular, immobile, non-tender, overlying skin normal, no sinuses, not lifting pinna. Dentition normal. Submandibular gland enlarged, mobile, no ducts discharge. There was mild proptosis of right eye, pupils were normal size reacting to light with normal movement, fundus normal, no xerosis, Schirmer’s test was normal( for tear film adequacy). On abdominal examination, liver was palpable 3 cms below costal margin, no splenomegaly, no free fluid, and no lump, testicles normal, Chest was clear, in cardiovascular system S1 S2 normal. Central nervous system examination was normal and in locomotor system joints were normal.
The probable diagnosis was kept as one of the possibilities could be lymphoreticular malignancy. It was also thought as an autoimmune disorders (Mikulicz’s syndrome, Sjogren’s syndrome) or tuberculosis, or primary or secondary salivary glands neoplasms, also can be chronic sialo-adenitis or eosinophilic granuloma.
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