Solitary eyelid xanthogranuloma in an immunocompetent young adult: diagnostic challenges and insights

Eyelid xanthogranuloma is a rare non-Langerhans cell histiocytic disorder that typically occurs in children as juvenile xanthogranuloma or in adults as part of systemic diseases such as necrobiotic xanthogranuloma or adult -onset asthma with periocular xanthogranuloma. Isolated eyelid involvement without systemic association is distinctly uncommon. We report a 26-year- old immunocompetent male presenting with a solitary, firm, nodular swelling over the lateral right lower eyelid for three months. Magnetic resonance imaging (MRI) orbit revealed a well-defined subcutaneous lesion (10x 8 mm) without orbital extension. Complete surgical excision was performed and histopathology confirmed non- Langerhans cell xanthogranuloma. Systemic evaluation was unremarkable. The patient received a single postoperative intralesional corticosteroid injection to reduce recurrence risk and remained asymptomatic with no recurrence or systemic disease over one year of follow-up. This case highlights the importance of considering xanthogranuloma in the differential diagnosis of isolated eyelid masses in young adults and demonstrates excellent outcome with surgical excision and adjunctive intralesional steroid therapy. A thorough systemic evaluation is mandatory to exclude underlying systemic disease and to guide appropriate long- term surveillance.