Unilateral dacryoadenitis as the sole presenting sign of Wegener's granulomatosis

The purpose of this case report is to present a patient in whom acute unilateral dacryoadenitis was the sole presenting sign of Wegener's granulomatosis. An 80-year-old man presented with swelling of the temporal part of his right upper lid. Imaging studies and an incisional biopsy were done. The patient expired from a massive pulmonary hemorrhage before any diagnosis could be reached. Imaging studies revealed an enlarged lacrimal gland. Initially, a presumptive diagnosis of lacrimal gland lymphoma or an idiopathic inflammation was made. The histopathological examination established the diagnosis of Wegener's granulomatosis. This is an unusual case of Wegener's granulomatosis, with a fulminantly fatal conclusion reminding that this disease must be considered in the differential diagnosis of acute unilateral isolated dacryoadenitis in the elderly, and that a rapid diagnosis is mandatory.