More Than Meets the Eye: Idiopathic Orbital Inflammation Mimicking Orbital Cellulitis.

Nicholas C Lee,Jaspreet Loyal,Adam Berkwitt

doi:10.7759/cureus.12655

Abstract

An 18-year-old female presented with left eye periorbital swelling, erythema, and pain for three days. Computed tomographic images showed swelling of the medial rectus muscle, and she was diagnosed with orbital cellulitis and initiated on empiric antibiotics. Over the next 48 hours, she did not clinically improve, resulting in an MRI and further workup of infectious, oncologic, endocrinologic, and rheumatologic etiologies was unrevealing and ruled-out malignancy, sarcoidosis, Wegner’s, and thyroid eye disease.Given the negative workup, the presentation was determined to be consistent with idiopathic orbital inflammation (orbital myositis variant) via a diagnosis of exclusion. Therefore, the patient was empirically treated with intravenous steroids that produced pronounced improvement within 24 hours. The patient was discharged in improved condition with a prednisone taper and rheumatology follow-up. Idiopathic orbital inflammation is a rare diagnosis of exclusion in pediatrics that merits prompt consideration and work-up if treatment for orbital cellulitis does not progress as expected.

Highlights

Pediatricians are frequently confronted with orbital swelling as a chief concern, and the instinctive differential diagnosis usually centers on orbital versus pre-septal cellulitis
Idiopathic orbital inflammation is a rare diagnosis of exclusion in pediatrics that merits prompt consideration and work-up if treatment for orbital cellulitis does not progress as expected
Our case report illustrates an 18year-old girl who was admitted with presumed orbital cellulitis that required a broad differential of infectious, oncologic, endocrine, and rheumatologic etiologies

Summary

Introduction

Pediatricians are frequently confronted with orbital swelling as a chief concern, and the instinctive differential diagnosis usually centers on orbital versus pre-septal cellulitis. The patient completed over 48 hours of intravenous antibiotics without improvement in eye pain, swelling, or erythema. At this time, magnetic resonance (MR) images showed nonspecific enhancement and enlargement of the left medial rectus muscle without abscess formation. The patient showed dramatic clinical improvement within 24 hours of steroid administration with a significant reduction in her orbital pain, swelling, and erythema. She was subsequently discharged to complete an extended prednisone taper with rheumatology and ophthalmology follow-up. Reference Ranges (4.0-10.0) (37-84) (8-49) (0-7) (12.0-18.0) (140-440) (0-20) (0.01-0.3) (3.5-5.0) (1.0-2.2) (8-52) (24-170) (0.3-4.2) (0.8-1.8) (

Discussion

Conclusions

Disclosures

Findings

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