Folliculitis Extending into Preseptal Cellulitis and Abscess in Children

Abstract

Objectives: To report a rare and complicated case of folliculitis extending into preseptal and orbital abscess in a young boy. Case Report: An 11 month-old boy presented with frontal mass since 7 days and swelling, redness and pain of left eye since 3 days. A multidisciplinary approach was undertaken to find the etiology of infection, rule out malignancy, and confirm the diagnosis. Orbital MRI with contrast revealed cellulitis with multifocal abscess at the left eyelid, fronto-nasal region, and intra-orbitally. The patient underwent incisional biopsy and drainage of the abscess after 10 days of intravenous antibiotic and steroid resulting in only mild improvement. Histopathologic examination confirmed of abscess and culture revealed Staphylococcus aureus. Two months later, eyelid swelling completely resolved and visual acuity were 6/12 OU. Conclusion: Multidisciplinary assessment is required to differentiate preseptal or orbital cellulitis and malignancy, especially in children. Aggressive intravenous antibiotics with steroid therapy are required to control infection. Surgical intervention must be promptly undertaken when there is no significant clinical improvement with conservative management or if there is evidence of abscess.