Abstract

Introduction-Nodular episcleritis is a common manifestation of tuberculosis (TB) and autoimmune disorders like rheumatoid arthritis.
Materials-50-year female presented with nasal painless congested episcleral nodule since 3 months. TB and autoimmune workup negative. No resolution after oral or intravenous corticosteroids. Right eye nasal yellowish-gray episcleral elevation noted, with overlying telangiectatic vessels. Ultrasound biomicroscopy showed a hyperechoic nodule, separate from sclera. No palpable lymph nodes. Excision biopsy was done.
Results-Vacuolated multinucleate giant cells seen arranged in whorls & clusters. No nuclear atypia. Xanthogranuloma diagnosis made. Systemic workup showed a deranged lipid profile with raised triglycerides and LDL-cholesterol. No intraocular lesions of xanthogranulomatosis. Carotid artery doppler and echocardiogram were unremarkable.
Conclusions-Episcleral xanthogranulomatosis is a rare, and can aid in early diagnosis of systemic conditions.