Eight year old boy born and living in Sierra Leone who consulted Saint John of God Hospital in Sierra Leone for a lump on the lower eyelid of the left eye with an evolution time of about one month. The father reported a history of contact with papaya leaves.
On examination, there was a hard lump covering the outer two thirds of the lower left eyelid, with ulcerations on the skin surface and mucosa of the lower left eyelid. There were also adenopathies on both sides of the neck. The rest of the examination showed no relevant findings.

The impossibility of performing microbiological cultures in the field made it necessary to administer systemic and local antibiotic coverage as the first therapeutic option in case it was an infectious process. Oral amoxicillin/clavulanic acid, and topical tobramycin and acyclovir were administered. However, the most striking symptom was the stony consistency of the tumour, together with regional lymphadenopathy suggestive of a neoformative process. Finally, contact with papaya led to the possibility of contact dermatitis due to the latex exuded by these fruits when they are green1. A skin biopsy was performed and sent to a referral hospital.
Pathology showed a fibrin and polynuclear exudate in the superficial area of the ulcer and granulation tissue in the deep regions, where histiocytes with herpes-like intranuclear inclusions and giant multinucleated cells with nuclei containing intranuclear inclusion bodies were identified. Skeletal muscle from the deepest biopsy site showed a non-specific focal inflammatory reaction. PAS staining was negative. The diagnosis was: ulcerated lesion with features compatible with herpes virus infection, accompanied by probably bacterial superinfection.

After three weeks, the lower eyelid tumour began to decrease in size, as did the induration, while the ulcerations healed. At one and a half months, the repair was complete.