Faculty Bibliography

Ticks are a well-known vector for viral, bacterial, and rickettsial infections, many of which are accompanied by cutaneous eruptions, but the bite itself can induce a spectrum of inflammatory reactions, including foreign body granuloma, tick bite alopecia, and cutaneous lymphoid hyperplasia. We describe the development of an indeterminate cell histiocytic infiltrate at the site of a tick bite. Although the etiology of intermediate cell histiocytosis is not well understood, this case raises the possibility that such infiltrates may represent an inflammatory reaction in some patients.

Persistent facial swelling may occur as a rare complication of rosacea. This finding has been referred to as lymphedematous rosacea, Morbihan's disease or persistent solid facial edema. A literature review for cases of lymphedematous rosacea revealed that the chronic inflammatory process that accompanies the disease contributes to an increase in the permeability of blood vessels. With time, the lymphatic drainage system becomes permanently impaired, leading to fluid accumulation in the affected skin. Herein, we report the case of a 58-year-old female with history of rosacea who developed bilateral periorbital swelling with associated erythema of the conjunctiva (ocular rosacea) over a 4 month period that only responded to oral corticosteroids. Biopsy revealed changes of lymphedematous rosacea.