Linear IgA bullous dermatosis induced by moxifloxacin

Abstract

apy with a cyclophosphamide, doxorubicin, vincristine and prednisolone regimen was started. The differential diagnosis of unilateral eyelid erythema and oedema is broad, and includes cellulitis, herpes zoster infection, insect bite, hordeolum, dacryocystitis, and malignant disorders such as lymphoma. Periorbital cellulitis is an uncommon, potentially devastating condition that can lead to serious sequelae, including blindness, intracranial infection and even death. Periorbital cellulitis is classified into preseptal or postseptal cellulitis depending on its relationship with the orbital septum. Compared with postseptal cellulitis, preseptal cellulitis is characterized by periorbital swelling and erythema without proptosis, ophthalmoplegia and loss of vision. Primary cutaneous ALCL of the eyelid is very uncommon, and is often misdiagnosed owing to the similarity between the clinical features of ALCL and preseptal cellulitis. To our knowledge, only six cases of primary cutaneous ALCL of the eyelid have been reported previously (Table 1). Almost all of the patients in these reports presented with an ulcerated inflamed nodule on the eyelid, and the initial diagnosis in all six cases was of preseptal cellulitis. As with our patient, the lesions in these patients failed to respond to systemic antibiotics. Following the diagnosis of ALCL, all patients underwent complete excision, along with chemotherapy or radiotherapy. They remained clinically and radiographically free of disease after treatment, and all had favourable outcomes. The clinical features of primary cutaneous ALCL of the eyelid, which include painful inflamed periorbital swelling, can closely mimic those of preseptal cellulitis. The distinctive features of primary cutaneous ALCL include ulcerated nodules and a failure to respond to systemic antibiotics. In conclusion, we report a patient with ALCL of the eyelid, initially diagnosed as preseptal cellulitis. Dermatologists need to be aware of this condition and perform adequate testing to ensure the correct diagnosis and treatment of potential cutaneous ALCL. H.-R. Moon, G.-H. Park, J. M. Jung, C. H. Won, S. E. Chang, M. W. Lee, J. H. Choi, and K. C. Moon Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 445-170, Korea E-mail: borelalgebra@gmail.com Conflict of interest: none declared. Accepted for publication 7 February 2013