Systemic granulomatosis after surgical injection of silicone oil for retinal detachment in a child affected by Fisher-Evans syndrome

Silicone oil is used for compli- cated retinal detachment, but it can be associ- ated with relevant side effects.We report a 6- year-old South American female admitted to ourhospitalwithsteroid-resistantFisher-Evans syndrome.Shealsohaddevelopedaretinalde - tachment, managed with intravitreal oil injec - tion. During treatment for Fisher-Evans syn - drome, she progressively developed recurrent andrefractorybronchospasm,peaksofhypere - osinophilia and orbital soft-tissue swelling. De - spite the persistent negativity of all microbio - logictests,shewastreatedempiricallywithan - tibiotics.Failureofthetreatmentledtotheexe - cution of a biopsy of the periocular tissue that revealed an intense polymorphous infiltrate constituted by numerous monoclonal popula - tion (FR2 monoclonality) of plasma-cells. A di- agnosis of lymphoma with plasmacytoid differ - entiation was suspected and cytotoxic treat - mentwasstartedwithoutresponse.Fortheap - pearance of swelling in left parotid and latero - cervical region, an excisional biopsy was per - formedandadiagnosisofgranulomatousreac - tion to ocular implant of silicone oil was made. In consideration of the clinical evolution, enu - cleation was considered, but parents did not consent to the procedure until the child devel- oped cerebral lesions suspected to be silicone localizations. After enucleation, eosinophilic count normalized and the child no longer pre - sentedanynewepisodeoffeverorswellin g. CONCLUSIONS: In this patient a granuloma - tous reaction is present at distance from the site of oil injection.This case suggests caution in using this substance even in ocular dis - eases, especially in immunocompromised pa - tients.