DR. SAHIL AGRAWAL

Dr.Rachna Meel, Prof.Dr. SEEMA KASHYAP, Dr.SUJEETH MODABOYINA

Abstract

Elderly female with complaints of red, itchy right upper lid since 6 months reported to us. She has been doctor shopping and managed as recurrent blepharitis.

On examination, there was mild erythema, loss of lashes, mild thickening and slight distortion of the lid margin locally, a recurrent unilateral blepharitis like picture of upper lid with no systemic complaints. Keeping the differential of sebaceous cell carcinoma, we did an incision biopsy, which to our surprise revealed a non-casseating granuloma.

So a systemic workup for her including LFT, RFT, ECG,Serum ACE, Ca+2, ANA, c & p–ANCA was ordered & were within normal limits. So keeping suspicion of TB(endemic in India), gene-expert for M.TB turned to be negative. Later at pulmonology, PFT show mild restrictive lung disease, HRCT chest was suggestive of sarcoidosis & confirmed on TBNA-EBUS from mediastinal lymph nodes. She was started on oral steroids and after a month of treatment, the eyelid itch and lid changes responded well.