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M.R. Criden, D.S. Bardenstein, G.A. Schnur; Successful Treatment With Doxycycline of Orbital and Multifocal Reactive Lymphoid Hyperplasia (RLH) Due to Presumed Chlamydia Psittaci . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5414.
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Purpose:To describe a successful treatment of RLH, suggesting a novel etiology. Increasingly, lymphoproliferative diseases, such as gastric lymphoma, are felt to have bacterial causes which allow them to be be treated with antibiotics instead of more toxic therapies. The 2 most common orbital tumors are ocular adnexal lymphoma (OAL) and the closely related RLH. One report has identified Chylamdia psittaci in patients with ocular adnexal lymphoma, some of which were successfully treated with doxycycline. We report successful treatment of orbital and multifocal RLH with doxycycline, which was refactory to steroid treatement. Methods: A 31 yo male presented with an orbital mass. Tissue from an open biopsy studied with histology and immunophenotypic analysis demonstrated RLH. Systemic evaluation by an oncologist and imaging studies revealed multiple areas of lymphadenopathy. Axillary node biopsy also demonstrated RLH. Extensive evaluation for infectious and inflammatory adenopathy were negative. Five months of treatment with oral prednisone showed marked reduction in symptoms and size of masses. Following prednisone termination, orbital pain and systemic adenopathy returned. Based on the possibility of a Chlamydial etiology we offered antibacterial therapy as an alternative to steroid therapy. The patiented elected antibacterial therapy. Treatment with doxycycline 100 mg tid orally for two weeks was initiated. Results: Three weeks after cessation of doxycycline symptoms resolved and there was a marked reduction in the size of all masses. The patient remained asymptomatic and without recurrent masses. Conclusions: The superior response to short–term doxycyline, in contrast to long–term steroid treatment, suggests a bacterial etiology for RLH. Along with data identifying Chlamydia and Helicobacter pylori in orbital lymphoma, these results suggest that all orbital lymphoproliferative diseases be evaluated for bacterial etiology. If such studies are not available, and given the far greater rate of complications for systemic steroids, radiation, and chemotherapy, then empiric trials of antibacterial therapy should be considered. The implied mechanism of a bacterial infection causing chronic inflammation, which develops into RLH or OAL, helps explain how the ocular adnexa, which has no intrinsic lymphoid tissue, develops these as its most common tumors.
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