Ishak Farhana, Hassan Siti Nur Baizury, Abdul Rahim Adlina
Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, MYS.
Cureus. 2024 Oct 3;16(10):e70759. doi: 10.7759/cureus.70759. eCollection 2024 Oct.
Orbital cellulitis is an infection of the orbital tissue behind the orbital septum. We report a case of a 71-year-old Malay lady, a passive smoker for 20 years, presenting with recurrent orbital cellulitis at the same site. She initially presented with right periorbital swelling, redness, and reduced vision worsening over two weeks, along with a firm swelling over the right temple. CT of the brain and orbit revealed a homogenous mass extending from the right sphenoid bone to the right orbit. The initial diagnosis was right sphenoid meningioma or metastasis. Her symptoms improved after 10 days of intravenous cefuroxime, prescribed for catheter-related phlebitis over her right hand, which developed during the admission. A follow-up MRI of the brain and orbit showed osteomyelitis changes in the right orbit and sphenoid bone. Histopathology revealed chronic inflammation without malignancy, and cultures were negative. The diagnosis was revised to right orbital cellulitis secondary to cranial osteomyelitis. The patient was lost to follow-up but returned three months later with recurrent symptoms, including right periorbital swelling, reduced vision, ophthalmoplegia, and right forehead swelling. She was treated with intravenous ceftriaxone, which resulted in partial symptom resolution. Neurosurgery planned a right craniotomy, but she was undecided and again lost to follow-up due to deteriorating health. Over time, her condition worsened, leading to readmission. A repeated CT scan of the brain and orbit showed a lobulated, enhancing soft tissue lesion in the right periorbital area with intralesional calcification and bony erosion. A biopsy confirmed it as high-grade B-cell lymphoma. The patient succumbed to the illness a few weeks later. This case highlights that orbital lymphoma can manifest as orbital cellulitis. Failure to respond to conventional orbital cellulitis treatment should raise suspicion of a more serious underlying cause. We advocate that clinicians consider orbital lymphoma as a potential diagnosis in elderly patients presenting with recurrent, culture-negative orbital cellulitis.
眶蜂窝织炎是眶隔后方眶组织的感染。我们报告一例71岁的马来女性病例，该患者有20年的被动吸烟史，同一部位反复出现眶蜂窝织炎。她最初表现为右侧眶周肿胀、发红，视力在两周内逐渐下降，右侧颞部有坚实的肿胀。脑部和眼眶CT显示一个均匀的肿块从右侧蝶骨延伸至右侧眼眶。初步诊断为右侧蝶骨脑膜瘤或转移瘤。因入院期间右手出现与导管相关的静脉炎，给予静脉注射头孢呋辛10天后，她的症状有所改善。脑部和眼眶的后续MRI显示右侧眼眶和蝶骨有骨髓炎改变。组织病理学显示为慢性炎症，无恶性病变，培养结果为阴性。诊断修订为继发于颅骨骨髓炎的右侧眶蜂窝织炎。该患者失访，但三个月后因症状复发再次前来，症状包括右侧眶周肿胀、视力下降、眼球运动障碍和右侧前额肿胀。给予静脉注射头孢曲松治疗，症状部分缓解。神经外科计划进行右侧开颅手术，但她犹豫不决，随后因健康状况恶化再次失访。随着时间的推移，她的病情恶化，导致再次入院。脑部和眼眶的重复CT扫描显示右侧眶周区域有一个分叶状、强化的软组织病变，内有病灶内钙化和骨质侵蚀。活检证实为高级别B细胞淋巴瘤。几周后患者因病死亡。该病例突出表明眼眶淋巴瘤可表现为眶蜂窝织炎。对传统眶蜂窝织炎治疗无反应应引起对更严重潜在病因的怀疑。我们主张临床医生在老年患者出现反复、培养阴性的眶蜂窝织炎时，应将眼眶淋巴瘤作为一种潜在诊断加以考虑。
