Ringworm causing childhood preseptal cellulitis.

A 4-year-old girl had redness and swelling of the left upper eyelid of 1 week's duration. She had been treated with topical fusidic add and oral flucloxacillin without resolution. Ophthalmic examination showed a diffuse, erythematous, tender lesion affecting the entire upper eyelid. There was a central area of skin ulceration with marked bleeding and discharge. Also found were small vesicles under the left eyebrow. The child's mother had noticed a scaly rash on her own forearm. Examination under anesthesia was carried out to assess the globe and to obtain samples for microbiology investigation. Microbiology scrapings showed fungal hyphae of the Dermatophyte group. Treatment with Griseofulvin was commenced, and complete resolution of the lesion occurred. To our knowledge there is only one similar case reported in the literature describing ring-worm as a cause of preseptal cellulitis. This case highlights the importance of considering alternative diagnoses when standard antibiotic treatment has failed.