Kikuchi-Fujimoto Disease Presenting as Refractory Eyelid Lesions Mimicking Chalazia

Kikuchi-Fujimoto disease is a rare, benign, self-limited inflammatory disorder characterized by necrotizing lymphadenitis. Ocular manifestations are uncommon, and periocular involvement is rare. We report a 16-year-old male with a remote history of biopsy-proven Kikuchi-Fujimoto disease who presented with a 2-year history of recurrent left upper and lower eyelid lesions clinically diagnosed as chalazia. Despite multiple incision and drainage procedures, the lesions recurred and were associated with progressive eyelid thickening and mechanical ptosis. Magnetic resonance imaging demonstrated diffuse cervical, parotid, and supraclavicular lymphadenopathy with enhancement of the lacrimal glands and eyelids. Biopsy of the eyelid lesions demonstrated necrotizing lymphohistiocytic inflammation with characteristic histopathologic and immunohistochemical findings supporting extranodal Kikuchi-Fujimoto disease and excluding lymphoma, chalazia, or infection. Following incisional biopsy and intralesional corticosteroid injection, the patient demonstrated marked clinical improvement without recurrence at postoperative month 1. To our knowledge, this represents the first reported case of Kikuchi-Fujimoto disease presenting as chronic eyelid lesions mimicking chalazia and further expands the spectrum of ophthalmic manifestations associated with this uncommon disease.