A 14-year-old female patient with no significant previous medical history apart from recent breathlessness on exertion presented with a rapidly enlarging left-sided superotemporal orbital mass confirmed by computerised tomography (CT). In order to rule out malignancy, an early biopsy of the mass was performed, which revealed necrotising granulomatous inflammation of the lacrimal gland.

Multiple lung nodules and hilar lymphadenopathy were discovered on imaging of the chest. This finding, along with a positive Mantoux test in the presence of …