Unifocal Langerhans cell histiocytosis - An atypical presentation

This is a report of unifocal langerhans cell histiocytosis presenting atypically as a fungating granuloma in a 12-year-old boy. There was a history of incision and drainage for a tender upper eyelid swelling mistaken for a lid abscess. An exuberant granulomatous growth developed at the site of the incision, which did not regress with antibiotics and anti-inflammatory agents. Incision biopsy and histopathological examination showed eosinophils and Langerhans cells, thus confirming the diagnosis. Treatment with intralesional steroids resulted in a remarkable and complete regression. Although upper lid eosinophilic granulomas are known to occur, this is a unique case on account of its presentation, which has not been reported before.