Angiolymphoid hyperplasia with eosinophilia

A 51-year-old Thai man had had a 5 cm x 7 cm swelling of the right upper eyelid and forehead for 4 months. There was a deep trench-like skin ulcer at the upper tarsal border, exuding thick, very foul smelling pus. The mass did not respond to treatment with massive, multiple antibiotics, although the pus and foul smelling improved after treatment directed against anaerobic organisms. The correct diagnosis of angiolymphoid hyperplasia with eosinophilia was finally made after the fourth biopsy. The swelling disappeared after four weekly intralesional injections of triamcinolone.