Sequential right then left acute dacryoadenitis in Crohn's disease

A 41-year-old woman presented with painful swelling of the lateral aspect of the right upper lid along with ipsilateral conjunctival injection. Her right eye had limited abduction and pain on attempted lateral gaze. Funduscopy was normal. Medical history included Crohn's disease treated with su...

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Bibliographic Details
Published in:BMJ case reports 2012-10, Vol.2012, p.bcr2012006799
Main Authors: Boukouvala, Stavroula, Giakoup-Oglou, Ismail, Puvanachandra, Narman, Burton, Benjamin J L
Format: Article
Language:English
Subjects:
Abscesses
Adult
Antibiotics
Crohn Disease - complications
Crohn Disease - drug therapy
Crohn's disease
Dacryocystitis - drug therapy
Dacryocystitis - etiology
Exocrine glands
Female
Humans
Leukocytes
Rare Disease
Steroids
Steroids - therapeutic use
Thrombosis
Thyroid gland
United Kingdom
White
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Summary:A 41-year-old woman presented with painful swelling of the lateral aspect of the right upper lid along with ipsilateral conjunctival injection. Her right eye had limited abduction and pain on attempted lateral gaze. Funduscopy was normal. Medical history included Crohn's disease treated with sulphasalazine and azathioprine. White blood cell count, erythrocyte sedimentation rate and C reactive protein were raised. CT of orbits revealed right-sided lacrimal gland enlargement, with signs of abscess formation within it. She was treated initially with intravenous antibiotics for 3 days and then switched to orals but it took 2 weeks for full resolution of symptoms. Eight months later, she presented again with signs of acute left-sided dacryoadenitis, not responding at all to oral antibiotics after 3 days. She was subsequently started on oral steroids, and her symptoms resolved within 48 h. Steroids were tapered without any recurrence after a period of 6 months.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2012-006799