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Granulomatous Inflammation Induced by Bee Sting Online Only

Hye Sun Park, MD1; Jeong Hyun Lee, MD, PhD1
[+] Author Affiliations
1Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
JAMA Ophthalmol. 2016;134(8):e161024. doi:10.1001/jamaophthalmol.2016.1024.
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This case report describes a woman in her 50s who presented with pain and swelling of the left periorbital area.

A woman in her 50s presented with pain and swelling of the left periorbital area. One month prior, she had received bee venom acupuncture at an Asian medical clinic as treatment for visual dimness. Her physical examination revealed left exophthalmos, eyelid swelling, and a palpable mass along the inferomedial orbital rim. Contrast-enhanced magnetic resonance imaging revealed an infiltrating mass that involved the left inferior oblique muscle, intraorbital fat, the infraorbital nerve, and the left pterygopalatine fossa (Figure, A). An incisional biopsy demonstrated a hard, whitish mass firmly adherent to the orbital floor. On pathological examination, chronic granulomatous inflammation with focal necrosis was identified without evidence of acid-fast bacilli or fungal organisms (Figure, B). The patient’s symptoms rapidly improved after intravenous methylprednisolone therapy. Bee sting therapy is a traditional herbal medical procedure in Asian and Middle Eastern countries.1 The bee sting leaves behind a poison sac and neural plexus. The retained materials induce activation of macrophages and produce a granulomatous inflammation.1,2

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A, Contrast-enhanced magnetic resonance imaging (MRI) scan reveals an infiltrating mass involving the left periorbital and intraorbital soft tissue and the left inferior orbital fissure (arrows). B, Histopathologic examination reveals granulomatous inflammation with focal necrosis and multinucleated giant cells (hematoxylin-eosin, original magnification ×200).

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