Resolution of refractory orbital cellulitis in an immunocompetent child: A case report

Introduction Orbital cellulitis in children is a potentially fatal emergency and develops rapidly, leading to severe visual loss and life-threatening complications. Presentation of case We report a case of a 16-month-old girl who presented to the emergency department unconscious with a four-day history of a swollen right eyelid. CT scan revealed soft tissue swelling at the superior and inferior palpebral region with bilateral maxillary sinusitis. She had a severe sepsis and received intravenous antibiotics. After her general condition improved, she underwent surgical drainage in conjunction with mini-FESS (functional endoscopic sinus surgery)-the culture of purulent material from which Staphylococcus Aureus was isolated. After a few days, she had hospital-acquired pneumonia, and an abscess in her right eyelid reformed. Immunoglobulin test and lymphocyte subset test was normal. The patient underwent re-surgical drainage and had complete resolution of refractory orbital cellulitis. Discussion Severe refractory orbital cellulitis secondary to indolent infection is oftentimes found in immunocompromised patients or in those with underlying ocular diseases; our immunocompetent patient had a seemingly mild case of sinusitis which quickly progressed to severe orbital cellulitis. Oftentimes, broad-spectrum antibiotics are sufficient to treat orbital cellulitis, however, the same cannot be said for our patient, abscess reformed despite appropriate definitive antibiotic therapy in accordance with the culture results. Conclusion While the main treatment of orbital cellulitis is administration of antibiotics, in certain conditions as found in our patient, patients may not respond well to conservative treatment. Thus, close monitoring is essential, and any sign of progression warrants prompt surgical drainage.
Highlights • Severe orbital cellulitis from mild sinusitis can occur despite immunocompetence. • Unresponsiveness to definitive culture-based antibiotic treatment before surgery • Prompt surgical drainage must be considered if patient shows signs of progression. • Nosocomial infection and sepsis may complicate orbital cellulitis.