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Article
November 1994

Neutrophilic Eccrine Hidradenitis Simulating Orbital Cellulitis

Author Affiliations

From the Departments of Ophthalmology (Dr Bardenstein), Medicine (Drs Haluschak and Gerson), and Dermatology (Dr Zaim) and the Institute of Pathology (Drs Bardenstein and Zaim), Case Western Reserve University, Cleveland, Ohio.

Arch Ophthalmol. 1994;112(11):1460-1463. doi:10.1001/archopht.1994.01090230074023
Abstract

Orbital swelling in patients with cancer can reflect neoplastic or infectious processes. Accurate diagnosis can be especially difficult in the face of associated fever and neutropenia. We treated a 30-year-old man undergoing induction chemotherapy for acute myelogenous leukemia, who had fever of unknown origin and periorbital swelling suggestive of orbital cellulitis. However, the periorbital findings were more compatible with passive swelling and hemorrhage. A skin biopsy specimen demonstrated isolated neutrophilic inflammation and necrosis of the eccrine glands. Cultures of the tissue for bacteria and fungi were negative. Pertinent literature regarding eccrine-gland inflammatory disease was reviewed. This unusual entity, termed neutrophilic eccrine hidradenitis, is most common in patients undergoing induction chemotherapy. Cases with infectious causes and cases in neutropenic patients have also been reported. No other patients, to our knowledge, with periocular involvement by neutrophilic eccrine hidradenitis have been described. Neutrophilic eccrine hidradenitis should be added to the differential diagnosis of cases of periocular hemorrhage and swelling in patients with cancer who receive chemotherapy.

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