1. I also agree with others that this is not the typical presentation of orbital cellulitis. The subacute onset and intermittent proptosis doesn’t correlate with the picture.

    1. While somewhat atypical in presentation, it is the most likely diagnosis from the listed choices presented with the case.

  2. Thanks for the quiz. I still don’t know why the diagnosis is not a Lymphangioma. I assume a history of chronic and recurrent proptosis with sudden exacerbation is not a key feature seen in orbital cellulitis (my opinion).

    1. While lymphangioma is certainly on the differential, given the periobital skin erythema and edema, the MOST LIKELY diagnosis is orbital cellulitis. Lymphangiomas are most common following an upper respiratory infection and patients typically experience proptosis and perhaps conjunctival hemorrhage but not erthythema and tense edema of the eyelids such as in this patient.

  3. Gracias por presentar casos clínicos de diferentes patologías.
    El discernimiento es muy aleccionador.

    1. Agree, while fungal infections are more common in tropical climates, they are still relatively less likely to happen in healthy individuals. This patient was not known to be either diabetic or immunosuppressed.

  4. Orbital cellulites: sight – life threatening case ,
    rapid onset of pain exacerbated by eye movement, swelling of the eye, and frequently visual impairment and double vision,optic nerve function impairment . There is commonly a recent history of nasal, sinus or respiratory symptom.
    The general condition of the patient is serious and bad .
    But why the story is chronic?from month?
    I must say that the general suitation is serious and bad in this story?
    I must do CBC ,CT of orbital and brain to exclude meningitis, cavernous sinus thrombosis (MRI?) Orbital abscess and mointor the proptosis ….etc
    Treatment :IV antibiotic
    When do you use IV antibiotic in preseptal cellulites ?younger children (poor complaince )
    Best regards

    1. IV antibiotics are generally indicated for cases of orbital cellulitis but may also be indicated in cases of preseptal cellulitis, typically in patients failing to respond to oral antibiotics or cases that occur in either infants or immunosuppressed individuals.

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