Objective: To investigate the clinical characteristics and independent risk factors of severe disease in patients with anti-nuclear matrix protein (NXP) 2 antibody-positive juvenile dermatomyositis (JDM). Methods: A retrospective cohort study was conducted, including 219 anti-NXP2 antibody-positive JDM patients admitted to 23 children's hospitals across China from July 2011 to July 2023. Patients were classified into severe and non-severe groups based on classification criteria for severe dermatomyositis. Demographic characteristics, clinical manifestations, and laboratory parameters were compared between the 2 groups using independent sample t-test, Mann-Whitney U test, or χ² test. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for severe disease. The receiver operating characteristic curve was employed to calculate optimal cut-off values. Results: Among the 219 patients, 108 were male and 111 were female, with an age at onset of 6.3 (3.5, 9.4) years. The severe group comprised 69 patients, and the non-severe group 150 patients. The severe group had significantly higher rates of fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, as well as elevated levels of ferritin-to-albumin ratio (FAR), creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (all P<0.05). Multivariate analysis identified anti-Ro52 antibody positivity (OR=13.26, 95%CI 1.37-128.29) and elevated FAR (OR=1.90, 95%CI 1.09-2.31) as independent risk factors for severe anti-NXP2 antibody-positive JDM (both P<0.05). Receiver operating characteristic curve analysis revealed that a FAR cutoff value of 6.82 predicted severe disease with an area under the curve of 0.87 (95%CI 0.81-0.94, P<0.001), sensitivity of 0.85, and specificity of 0.70. All patients received glucocorticoid therapy, and the severe group received higher proportions of steroid pulse therapy, cyclophosphamide, mycophenolate mofetil, intravenous immunoglobulin, biologics, and adjuvant treatments compared to the non-severe group (all P<0.05). In terms of outcomes, 2 patients (2.9%) in the severe group died (due to neurological involvement and intestinal perforation, respectively), while the remaining patients achieved complete clinical response or remission. All patients in the non-severe group achieved remission. Conclusions: The primary clinical features of anti-NXP2 antibody-positive JDM included fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, and elevated levels of CK, AST, LDH, and FAR. Furthermore, anti-Ro52 antibody positivity and a FAR>6.82 were identified as independent risk factors.

ABSTRACT Background Odontogenic orbital cellulitis (OOC) is a rare but serious complication of dental infections, accounting for 2%–5% of all orbital cellulitis cases. It can be life‐threatening if not promptly diagnosed and managed, particularly in vulnerable populations such as pregnant women. This case report discusses the complex management of OOC with deep neck space involvement in a Gravida 5 para 4 female at 27 weeks of gestation—an exceptionally rare scenario with only isolated cases reported worldwide. Case Presentation A 28‐year‐old pregnant female presented with right periorbital swelling, pus discharge and signs of orbital involvement following extraction of the right maxillary and mandibular third molars. Clinical examination revealed orbital oedema, limited ocular movements and purulent discharge from the extraction site. MRI revealed multiple abscesses extending into the parapharyngeal, masseteric and orbital spaces. Surgical intervention under local anaesthesia involved incision and drainage of the buccal, retromolar and orbital abscesses, along with the placement of drains. Post‐operative care included IV antibiotics and multidisciplinary monitoring by maxillofacial and ophthalmology teams. Conclusion Odontogenic orbital cellulitis during pregnancy presents unique diagnostic and therapeutic challenges. Prompt recognition, appropriate imaging, surgical drainage, antibiotic therapy and multidisciplinary coordination are essential for favourable maternal and foetal outcomes.

Hoagland Sign-A Common Diagnosis Preceded by an Uncommon Sign.

Aging leads to facial volume loss, particularly in the forehead, resulting in a flat appearance and static wrinkles. Effective forehead rejuvenation aims to restore volume while minimizing risks associated with filler injections. Hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) fillers are commonly used, with recent interest in hybrid techniques that combine both to optimize aesthetic outcomes. This study evaluates the efficacy and safety of a premixed hybrid filler approach for forehead rejuvenation. A multicenter retrospective cohort study analyzed 111 patients (108 females, 3 males) aged 18-43, who received hybrid injections of CaHA (Radiesse®) and HA (Belotero® Volume) at varying ratios based on forehead contour. The injection volumes and product ratios were customized according to the patients' needs. Follow-ups were conducted at 2 weeks, 3 months, 6 months and 12 months. Primary outcomes were adverse events (AEs) classified per Kadouch criteria; secondary outcomes included patient satisfaction. The cohort consisted of 108 women (97.2%) and 3 men (2.7%), mean age 30.5 years. The average injected volume was 3.11mL. Two transient minor AEs (1.8%) were reported: localized hematoma and periorbital edema, both resolving with conservative management. No cases of vascular compromise, nodules, migration, or long-term complications were observed. High patient satisfaction was reported across all evaluations. The combination of CaHA and HA fillers administered via a retrograde fanning injection technique in the deep forehead fat plane proved to be both safe and effective in improving frontal depressions, with no adverse events reported during the 12 month observation period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Costello Syndrome (CS) results from a germline mutation in the HRAS gene. Rhabdomyosarcoma in CS patients has arisen from various sites but not the orbit. We present the first case report of orbital rhabdomyosarcoma in a patient with CS. An 18-month-old male known for CS presented with progressively worsening proptosis and periorbital edema. On presentation, he had proptosis with inferolateral globe displacement, chemosis and injection. An urgent computed tomography scan revealed a left orbital mass extending from the posterior aspect of the globe to the orbital apex, and pathological examination confirmed embryonal rhabdomyosarcoma. Treatment with chemotherapy consisted of vincristine, dactinomycin, and cyclophosphamide, and received 8 cycles of photon beam radiation. Radiological surveillance up to 12 months showed no signs of recurrence or metastatic lesions. Patients with CS are at a high risk of developing rhabdomyosarcoma and clinicians should be vigilant in the context of any clinical orbital signs of disease.

Introduction: Carcinoid heart disease (CHD), a rare cardiac manifestation of neuroendocrine tumors (NETs), predominantly affects right-sided valves due to fibrotic plaque deposition from serotonin and other vasoactive substances. We describe a rare case of CHD in an elderly female. Description of Case A 69-year-old female with worsening periorbital and bilateral leg edema was referred for cardiology evaluation. She also reported exertional dyspnea and orthopnea. She denied weight loss, abdominal pain, or diarrhea. Physical exam revealed a flushed appearance with a left sternal border holosystolic murmur. A transesophageal echocardiogram (TEE) showed LV ejection fraction 60%, asymmetric LV hypertrophy, severe tricuspid regurgitation (TR) with thickened and immobile leaflets, flow reversal in the IVC and hepatic veins, thickened pulmonic valve with moderate pulmonic insufficiency and a dagger-shaped Doppler profile, and moderate aortic regurgitation (Fig 1). Given the flushing and TEE findings, CHD was suspected. A 24-hour urine 5-HIAA was markedly elevated at 81 mg, confirming carcinoid syndrome. Right heart catheterization revealed elevated RH pressures, torrential TR, and normal cardiac index. PET-CT showed a large pelvic mass arising from the left ovary with Ga-68 DOTATATE uptake in mediastinal and hilar nodes, consistent with metastatic disease (Fig 2). Pelvic MRI confirmed the ovarian mass concerning for NET (Fig 3). She was started on octreotide LAR 20 mg every 4 weeks by Medical Oncology, evaluated by cardiothoracic surgery, and underwent surgical replacement of the aortic, tricuspid, and pulmonic valves. Her postoperative course was complicated by pneumomediastinum and upper GI bleeding due to a Mallory-Weiss tear. Discussion: CHD is a serious manifestation of carcinoid syndrome, caused by serotonin-induced fibrous plaque deposition on tricuspid and pulmonic valves, leading to immobile leaflets and severe regurgitation. Primary ovarian NETs causing CHD are exceedingly rare, with only isolated case reports. Clinicians should suspect CHD in patients with right-sided heart failure, flushing, or characteristic echocardiographic findings—such as thickened valves and hepatic vein flow reversal—and confirm with elevated 5-HIAA levels.

Efficacy and safety of axatilimab in chronic graft-versus-host disease: A systematic review and meta-analysis.

We first described the extended transconjunctival lower eyelid blepharoplasty in 2017. In this prospective study, we present our long-term outcomes with this technique. Two hundred consecutive patients who underwent the extended transconjunctival lower eyelid blepharoplasty between June 2017 and December 2024 were prospectively evaluated. Ninety-six percent of patients received concomitant mid cheek fat grafting. The mean follow-up was 22 months. Two specific aspects unique to our technique were analyzed: (1) the long-term effects of releasing the tear trough ligament and orbicularis oculi origins, and (2) the use of free fat grafts, fashioned from excised orbital fat, placed along the orbital rim. Patients were evaluated for aesthetic outcomes, lower eyelid position stability, and dynamic changes with smiling. Patient satisfaction was assessed with an outcome questionnaire. This technique is both effective and safe in addressing eye bags and the tear trough deformity. No increase in the incidence of scleral show was observed. Free fat grafting, utilizing excised orbital fat, effectively corrected the tear trough deformity and softened the lid-cheek junction. Release of the orbicularis oculi origins consistently resulted in, long-lasting improvement in periorbital aesthetics during smiling, without compromising orbicularis oculi function. Patient satisfaction was high. The overall complication rate was low, with fat necrosis occurring in 3.0% of patients and a revision rate of 1.0% for residual lower eyelid bulges. This technique delivers superior aesthetic outcomes compared with conventional approaches that do not release the tear trough ligament. A novel finding in this study is that the technique predictably improves the aesthetics of the smile, which is a significant benefit.

Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy with 3 recognized subtypes, of which the sporadic form is the most prevalent outside mainland Africa. Sporadic BL typically presents in the abdomen, with fewer than 9% of cases involving the head and neck region; orbital presentation is even rarer. We report 4 pediatric cases of orbital BL and provide a comprehensive review of the literature, focusing on clinical presentation, imaging features, histopathology, genetic findings, and treatment outcomes. A multicenter retrospective case series combined with a literature review of pediatric BL cases with orbital involvement. Our analysis includes 28 published cases and 4 additional cases from our centers. Orbital BL typically presents with acute symptoms due to mass effect, such as proptosis, ophthalmoplegia, and periorbital swelling. All patients in our series were treated according to the French-American-British Mature B-Cell Lymphoma 96 protocol and are currently in remission. Poor prognostic indicators include elevated lactate dehydrogenase levels, central nervous system involvement, bone marrow infiltration, and disease relapse. Orbital involvement in sporadic pediatric BL is rare but should be considered in the differential diagnosis of a child presenting rapidly progressive proptosis. Prompt recognition and early treatment are associated with favorable outcomes.

Disclosure: M. Manolas: None. T. Lu: None. A. Regan: None. B. Wong: None.Background: Hashimoto’s thyroiditis is the most common cause of hypothyroidism, characterized by autoimmune thyroid destruction and the presence of TPO antibodies. Thyroid associated ophthalmopathy and dermopathy are most commonly seen in hyperthyroid conditions like Graves' disease, but they rarely can occur in patients with hypothyroidism as well. In some cases, patients with autoimmune thyroid disorder may exhibit both thyrotropin blocking antibodies and thyroid stimulating antibodies. Shifts in concentration of these opposing antibodies can result in fluctuations of thyroid function and variable clinical manifestations.Clinical Case: A 38 year old woman with a history of longstanding hypothyroidism, obesity, and obstructive sleep apnea presented with weakness and shortness of breath. On arrival, she was hemodynamically stable, with a blood pressure of 169/105 mmHg, heart rate of 74 bpm, and body temperature of 36.8°C. She was at baseline mental status, without concern for myxedema coma. She denied a history of hyperthyroidism, radioactive iodine ablation or prior neck surgery. Laboratory data revealed TSH >100 uU/mL (ref. 0.30 - 4.20), Free T4 0.5ng/dL (ref. 0.6 - 1.5), Thyroglobulin (Tg) antibody 27.6 IU/mL (ref. <1.0), Thyrotropin Binding Inhibitor Immunoglobulin (TBII) >40 IU/L (ref. <2.0), Thyroid Stimulating Immunoglobulin (TSI) 250% (ref. <140%), and TPO antibody 3.2 IU/mL (ref. <5.0). Thyroid ultrasound showed normal thyroid tissue without discrete nodules or hypervascularity. Physical exam was notable for bilateral proptosis, periorbital edema, acropachy of both hands with digital clubbing and significant lower extremity elephantiasis nostra verrucosa (ENV). Radiographs confirmed the typical periosteal reaction of acropachy. She was initially treated with IV levothyroxine before transitioning to oral formulation. By discharge, her FT4 and TSH had improved significantly. Conclusion: This case is a unique presentation of Hashimoto’s thyroiditis with ophthalmopathy, dermopathy with ENV, and acropachy in the context of hypothyroidism with positive Tg, TSI and TBII antibodies. The absence of hyperthyroidism despite elevated TSI suggests underlying glandular destruction, likely from Hashimoto’s Thyroiditis, resulting in a lack of response to stimulatory antibodies while the TSI is contributing to the extrathyroidal manifestations of autoimmune thyroid disease. Acropachy is the rarest extrathyroidal manifestation, occurring in about 0.3% of patients with Graves’ disease. ENV, a severe form of thyroid dermopathy, is linked to high titers of TSH receptor antibodies, as seen in our patient. This case highlights the unusual overlap of thyroid-stimulating and thyroid-blocking antibodies, underscoring the need for further investigation into the mechanisms driving antibody shifts in autoimmune thyroid disease and its clinical manifestations.Presentation: Monday, July 14, 2025

Disclosure: H. Angammana: None. M. Park: None. J. Pesantez: None. A. Sajan: None.Introduction: Myxedema coma is a rare endocrine emergency characterized by profound hypothyroidism with high mortality, often precipitated by infection, medication noncompliance or systemic illness. We present a case of refractory fatal myxedema coma complicated by acute hypoxic respiratory failure, septic shock and multiorgan failure. Case Presentation: A 79-year-old female with a history of hypothyroidism presented with progressively worsening lethargy for few days. She had been noncompliant with levothyroxine for several months. On admission, she was obtunded, hypothermic (90.5 °F), bradycardic (46 beats per minute), and hypotensive (88/50 mmHg). The physical exam revealed facial puffiness, periorbital edema, and generalized non-pitting edema. The laboratory findings were significant for Thyroid Stimulating Hormone (TSH) of 74 IU/mL [0.4-4.0] and free thyroxine (FT4) of 0.27 ng/dL [0.8-1.8]. She also had elevated white blood count (18.2 x10^9/L [4-11 x10^9]), elevated creatinine of 2.1 mg/dL [0.6-1.1], and hyponatremia (127 mmol/L [135-145]). She developed pneumonia with worsening respiratory distress and was intubated for airway protection. Shortly after, she had a lower gastrointestinal bleed requiring multiple blood transfusions. The patient was promptly started on intravenous levothyroxine, liothyronine, hydrocortisone, antibiotics and supportive care. Following initial stabilization, her TSH had improved to 4.76 IU/mL and mental status improved. She was subsequently downgraded to the general medical floor. However, she soon deteriorated in a few days with acute kidney injury requiring renal replacement therapy, newly diagnosed heart failure with a reduced ejection fraction (20%), bilateral pleural effusions and decubitus ulcers with osteomyelitis. She reverted to being lethargic and had a cardiac arrest secondary to aspiration. Given her poor prognosis, care was transitioned to comfort measures, and she passed away under hospice care. Her last drawn TSH was 13.83 IU/ml while on intravenous levothyroxine and liothyronine. Discussion: Myxedema coma continues to have a high mortality rate of about 50%. Predictors of poor prognosis include advanced age, persistent hypothermia, hypotension, bradycardia, sepsis, mechanical ventilation. The prognosis of myxedema coma remains difficult to determine due to its rarity. While early diagnosis and aggressive management have improved survival rates, complications such as sepsis, respiratory failure, and multiorgan dysfunction still result in poor outcomes like in our patient. Further research is needed to refine prognostic models and explore novel therapeutic strategies to improve survival in these patients.Presentation: Monday, July 14, 2025

Missed opportunities for diagnostic excellence are common and can lead to delayed diagnoses and initiation of treatment. Medical teams incorporate many elements into the diagnostic process, including patient factors, medical knowledge, data gathering, care environment, subspecialized personnel, and hospital processes. A case-based discussion describes how search satisfying-the tendency to stop searching once something has been found-and authority gradients can lead to delays in diagnosis. A 2-year-old girl repeatedly presents to the emergency department with vomiting and periorbital swelling progressing to esotropia, initially found to have normal short-sequence MR brain imaging. After nonspecific labs and reassuring initial imaging, ophthalmologic consultation obtained during the child's third emergency department visit proposed plausible diagnoses of benign post-viral esotropia or decompensated esotropia. When her exam worsened at ophthalmology clinic follow up, she was referred back to the emergency department for complete MR brain and orbit imaging leading to a diagnosis of bilateral orbital myositis. Examining the diagnostic process through integrated commentary, this case emphasizes the importance of recognizing limitations of short-sequencing advanced imaging and continuing the diagnostic pursuit in collaboration with consultants. A fishbone diagram visually demonstrates the factors that lead to a missed opportunity for diagnostic excellence. The case concludes with clinical teaching points in addition to a pitfall, myth, and pearl specific to search satisfying and authority gradients.

Ocular safety evaluation of toplic and systemic antifungal medications: A multi-source pharmacovigilance and genomic study.

BackgroundTraditional transconjunctival lower blepharoplasty procedures that remove only the orbital septal fat often fail to effectively correct tear trough deformities, and may even exacerbate lower eyelid hollowness. Thus, developing a comprehensive surgical technique that can simultaneously correct both eye bags and tear troughs holds great clinical significance.ObjectiveThis study aimed to evaluate a modified transconjunctival lower blepharoplasty technique that incorporates orbital fat repositioning and minimally invasive buried-guiding fixation to simultaneously correct eye bags and tear trough deformities. The goal was to restore a youthful contour of the lower eyelid and assess the clinical efficacy and safety of this approach.MethodsThis study was designed as a prospective, single-center cohort study. A total of 30 patients (3 males, 27 females; mean age: 28 years) with lower eyelid bags and tear trough deformities were enrolled in this study. These patients were treated at the Department of Plastic Surgery, Affiliated Hospital of Yangzhou University, between January 2022 and December 2024. All patients underwent transconjunctival lower blepharoplasty combined with a buried-guiding fixation technique to perform strong orbital fat anchoring and correct both deformities.ResultsAll 30 procedures were successfully completed with primary healing achieved. The average follow-up period was 6.2 months (ranging from 3 to 12 months). Postoperative outcomes showed significant improvement in both lower eyelid bags and tear troughs, with a more youthful midface appearance and no external scarring. Patient satisfaction was high.

Orbital complications of acute pediatric rhinosinusitis, such as subperiosteal and orbital abscess, meningitis, and intracranial extension, represent time-sensitive conditions requiring prompt diagnosis and management. Improved understanding of the anatomic, microbiologic, and clinical factors contributing to these complications is essential for optimizing outcomes. This review synthesizes current literature on the diagnosis and management of orbital complications in pediatric acute sinusitis, with emphasis on risk stratification, imaging indications, and surgical decision-making. Two representative case studies are included to illustrate diagnostic and therapeutic considerations. While pediatric patients may improve with medical therapy alone, abscess formation or progressive complications despite antibiotics often necessitate surgical intervention. Clinical presentation, ophthalmologic examination findings, and abscess characteristics are critical in risk stratification and determinants for surgical management. A high likelihood of suspicion of an underlying sinus disease is warranted when evaluating children with periorbital redness and swelling. Monitoring and further evaluation with imaging are critical to prevent acute rhinosinusitis with orbital complications and vision-threatening sequelae.

To report a VEXAS syndrome patient presenting with muscular manifestations, at diagnosis and to review the literature on this rare involvement. We conducted a narrative review through 3 databases (Cochran, PubMed and Google Scholar) to identify all reports of muscle involvement associated with VEXAS syndrome. No statistical analysis was performed. We reported a 73-year-old male VEXAS syndrome patient presenting with muscular manifestations with ptosis, trismus, lower limb myalgia and identified 15 other patients in the literature. All were male with a median age of 71. The most common UBA1 mutations in exon 3, codon 41 involved methionine 41. Muscle inflammation at the onset of VEXAS syndrome was diagnosed by MRI or CT scan. It mostly involved orbital and facial muscles (n = 7), causing diplopia, proptosis, periorbital oedema or chemosis, and the muscles of the lower limbs, causing myalgia, weakness or oedema (n = 7). Muscle histological analysis was also performed in a few cases (n = 5) and revealed an inflammatory infiltrate with macrophages. Other symptoms were quite common: fever, skin and lung involvement, chondritis, arthralgia and thromboembolic events. Corticosteroid therapy was a routine, and the use of corticosteroid-sparing agents was almost systematic. Taken together, these new data describe the specific muscle involvement of VEXAS syndrome and extend its phenotypic spectrum. It enables us to identify three very distinct manifestations of muscle involvement: orbital, facial, and lower limb inflammation. A case series study would provide a better description of these symptoms.

Abstract Background Osteotomy is a critical component of rhinoplasty but is associated with postoperative morbidity, including pain, edema, ecchymosis, and subconjunctival hemorrhage. Aim This study compares the outcomes of three osteotomy techniques—conventional, magic saw, and piezoelectric—in terms of operative performance and postoperative morbidity. Methods In this single-blinded, randomized trial, sixty individuals of Caucasian Mediterranean ethnicity underwent primary septorhinoplasty at Mansoura University Hospital (2022–2024). Patients were randomized into three groups (n = 20 each): Group 1 (conventional osteotomy), Group 2 (magic saw), and Group 3 (piezoelectric). All surgeries followed a standardized open rhinoplasty approach. Postoperative outcomes, including pain (VAS score), periorbital edema, ecchymosis, and subconjunctival hemorrhage, were assessed on days 1, 7, and 21. Functional and aesthetic results were evaluated using NOSE and SCHNOS scores at baseline, 1 month, and 6 months postoperatively. Results Piezoelectric osteotomy resulted in significantly lower pain, edema, ecchymosis, and subconjunctival hemorrhage on day 1 compared to conventional and magic saw techniques (p &lt; 0.05). By day 7, no significant differences remained among groups. All patients showed complete resolution of early complications by day 21. SCHNOS and NOSE scores improved significantly in all groups over time, with no intergroup differences at 6 months. Conclusion Piezoelectric osteotomy demonstrates superior short-term outcomes in reducing postoperative morbidity but requires longer operative time. Magic saws also reduce early complications relative to conventional techniques, though less consistently. Despite differences in early recovery profiles, all three techniques yield comparable long-term functional and aesthetic outcomes.

Hydralazine is the most common antihypertensive that causes drug-induced anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Upper airway involvement including hoarseness is rare in AAV and mostly associated with drug-induced lupus erythematosus (DILE). This case describes a 77-year-old woman on hydralazine who developed bilateral upper extremity pain, periorbital swelling and hoarseness requiring emergent intubation. Bloody secretions in bronchoscopy, joint pain and petechiae clinically suggested vasculitis. Anti-histone, myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies were positive and anti-nuclear antibodies (ANA) and imaging were negative. The patient was treated with high-dose steroids and hydralazine withdrawal. At one-year follow-up on azathioprine as a steroid-sparing agent, dysphonia had resolved. Hoarseness is an atypical feature of hydralazine-induced AAV and may indicate life-threatening upper airway disease. Dual-ANCA and anti-histone positivity, negative ANA status, may potentiate further investigation for dysphonia and AAV while on hydralazine. Early recognition, withdrawal of medication and timely steroids are essential to prevent severe airway complications.

Neonatal orbital cellulitis is an uncommon but serious infection that can lead to an orbital abscess, often requiring surgical intervention. We report a rare case of a term neonate presenting on day 20 of life with persistent fever and irritability without initial orbital signs. Blood culture revealed methicillin-resistant Staphylococcus aureus (MRSA), and intravenous vancomycin was initiated. By day 3 of admission, the infant developed periorbital swelling; imaging confirmed a retro-orbital abscess. With timely antibiotic therapy, the infection resolved without the need for surgical drainage. Notably, there was a history of inappropriate infant care practices, including bottle feeding and external application of native substances, which may have contributed to the infection. This case underscores the importance of considering orbital infections in neonates with sepsis of unclear origin, initiating early MRSA-targeted therapy and promoting good neonatal care practices. Conservative management may be successful in uncomplicated cases with early diagnosis and close monitoring.

Non-specific orbital inflammation (NSOI) is a complex diagnosis marked by inflammation of ocular tissues without an identifiable etiology. This case report describes a 37-year-old female with recurrent left-sided NSOI. Her early presentation included pain, proptosis, chemosis, and limited ocular movements. Imaging showed edema of the left optic nerve, hypertrophy of the extraocular muscles, enlargement of the lacrimal gland, and periorbital soft tissue edema. Although she initially exhibited a positive response to high-dose intravenous corticosteroids, her symptoms reemerged during the tapering process, requiring extended oral corticosteroid treatment. This case highlights the significance of a multidisciplinary approach, personalized treatment, and additional study into the fundamental processes and optimal management of this condition.