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Management of Orbital Xanthogranuloma with Methotrexate
  1. Ashley Hayen (ahayden{at},
  2. James T Rosenbaum (rosenbaj{at},
  3. David J Wilson (wilsonda{at}
  1. Keck School of Medicine, United States
  2. Casey Eye Institute, United States
  3. Casey Eye Institute, United States


    Background/Aims: To evaluate the efficacy of methotrexate therapy for the periorbital findings in adult onset xanthogranuloma (AOX).

    Methods: The medical records of three patients with AOX, with and without asthma, who were treated with methotrexate at Oregon Health & Science University. Diagnosis of AOX was made by biopsy in all patients. The patients were evaluated between Febuary 1998 and July 2006. All patients had failed prior medical and/or surgical treatment. Methotrexate was administered at 10- 15 mg per week with folate supplementation and a course of corticosteroids. Efficacy was based on improvement in skin discoloration, involvement of the visual axis, and patients' report of inflammation.

    Results: All three patients were started on methotrexate, but one patient discontinued treatment after 3 weeks due to nausea. With follow-up as long as 3 years, the two patients who continued treatment lost the yellow discoloration of their skin and they reported significantly less inflammation and ptosis after treatment. Oral corticosteroids could be reduced or discontinued.

    Conclusions: AOX is a rare, persistent disease that commonly involves the preseptal fat. Methotrexate is a therapeutic option for this illness.

    • Adult Onset Xanthogranuloma
    • Histopathology
    • Methotrexate
    • Orbit

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