Infraorbital eyelid edema as the presenting sign of bronchogenic carcinoma


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Abstract

A 59-year-old man presented at our department with a 4-week history of persisting and therapy-refractory infraorbital edema (Fig. 1). There was no previous history of eyelid edema, allergic reactions, autoimmune diseases, or new medications. Earlier therapy with corticosteroids and antihistamines was ineffective.The patient suffered from coronary heart disease and long-standing chronic bronchitis presenting with dyspnea on exertion. He had smoked 50 cigarettes per day since early youth. There was no history of worsening of his bronchogenic symptoms, weight loss, or night sweats over the last 3 months.Initial physical examination revealed marked infraorbital edema, enlarged liver, and decreased breath sounds in the left lung field. Moreover, there was a minor telangiectatic erythema localized to the periumbilical area and to the anterior chest. There was no suffusion of the neck and no remarkable peripheral edema.Laboratory parameters, including electrolytes, blood cell count, creatinine, transaminases, alkaline phosphatase, protein electrophoresis, C1-esterase inhibitor, C-reactive protein, immunoglobulin E, and thyroid parameters, were within normal limits.X-Ray of the chest detected a mediastinal widening. Computed tomography was performed and revealed a mediastinal tumor, 7 cm in diameter, reaching from the aortic arch to the heart. This tumor was compressing the superior vena cava, resulting in stasis of the leading vessels followed by infraorbital edema. Histopathologic examination of tumor biopsies led to the diagnosis of a bronchogenic small-cell carcinoma.Six cycles of polychemotherapy with doxorubicin, ifosfamide, and vincristine, radiation therapy (50 Gy), and intravascular stenting of the vena cava superior were performed.Following this treatment, regression of the tumor and a distinct decline in infraorbital edema were observed.

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