Minoxidil-Induced Diffuse Periorbital Edema Mimicking Lymphoproliferative Disorder: A Case Report
Author: Aleza Andron
Base Hospital / Institution: Shaare Zedek Medical Center
ePoster presentation
Abstract ID: 25-222
Purpose
Diffuse periorbital edema has a wide differential diagnosis including infectious, inflammatory and infiltrative etiologies. It is important to be aware of iatrogenic causes as well, as on biopsy some can mimic lymphoproliferative disorder.
Methods
A Retrospective case report
Results
A 57 year- old woman presented with painless significant bilateral periorbital edema and dermal hyperemia for 3 months duration. On ROS, she has been taking minoxidil for a year due hair loss and had one tear trough injection of hyaluronic acid (VOLIFT) 3 years prior. She had been treated with courses of oral and topical antibiotics, and oral antihistamines all with no improvement. Ocular exam was normal. Serum TSH, T3, T4, and IGG/Igg4 were all normal. On orbital CT scan, there was symmetric sub-dermal fullness in the periorbital area bilaterally with no post septal involvement. A biopsy was performed from the upper eyelid skin, and deeper eyelid tissue which showed lymphatic infiltrated muscle with a DD between atypical reactive changes and low grade lymphoproliferative disorder. Oral prednisone was prescribed with slight improvement. On hematological work up, PET scan showed increased uniform uptake in the periorbital area bilaterally that could be low grade lymphoproliferative disease. PCR for gamma gene rearrangement and PCR for igH gene rearrangement were both polyclonal; thus, there is no support for T cell or B cell lymphoproliferative disorder. A dermatologist was consulted as well who diagnosed minoxidil related eyelid edema s/p tear trough injection. The patient stopped the minoxidil and within 3 months the edema and hyperemia were largely resolved.
Conclusion
This case illustrates a rare side effect of common medication used to treat hair loss in combination with tear trough injection. Due to its potent vasodilatory effects, minoxidil is known to rarely cause pericardial effusion, frontal and eyelid edema. To our knowledge, this is the only reported case of a biopsy performed on a minoxidil induced edema tissue, and it is notable that lymphoproliferative disease was on the differential diagnosis.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Eva | Finkelstein | Hadassah Medical Center |
