Pediatric orbital cellulitis: Case report of an unusual etiology and pathogen

Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of Streptococcus constellatus/Parvimonas micra, and he received further antibiotics with full recovery. The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.

Acute Rhino-orbital-cerebral Mucormycosis in a Patient with COVID – 19

COVID-19 patients are known to have immunosuppression due to decreased lymphocytes and increased susceptibility to co-infections (Bacterial and fungal). We present a case of 61-year-old patient who had diabetes, hypertension and ischemic heart disease with COVID-19 infection admitted after RT-PCR positive result. He developed rhino-orbital Mucormycosis during treatment. He received Remdesivir with parenteral Methylprednisolone and Meropenem. While admitted in the ward, he developed signs of orbital cellulitis. Magnetic resonance imaging (MRI) of the brain, orbits, and paranasal sinuses revealed right frontal, ethmoidal, and maxillary sinusitis with the extension of the sinisuidal disease to the orbit. A nasal biopsy revealed broad aseptate filamentous fungal hyphae suggestive of Mucormycosis. Long-term use of steroids/monoclonal antibodies/broad-spectrum antibiotics may contribute to the predisposition to fungal disease. Early diagnosis and prompt management are warranted to avoid morbidity. Key Words: Mucormycosis, COVID – 19, Orbital Cellulitis.

Association Between Corticosteroids and Outcomes in Children Hospitalized With Orbital Cellulitis

OBJECTIVES: To examine the association between systemic corticosteroid use and outcomes for children hospitalized with orbital cellulitis at US children’s hospitals. METHODS: We conducted a multicenter observational study using administrative data from the Pediatric Health Information System database from 2007 to 2019. Children between the ages of 2 months and 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification or 10th Revision, Clinical Modification discharge diagnostic codes of orbital cellulitis were included. The primary exposure was receipt of systemic corticosteroids on the day of hospital admission. The primary outcome was hospital length of stay, and secondary outcomes included surgical intervention, ICU admissions, revisits, and health care costs. We used generalized logit model with inverse probability weighting logistic regression to adjust for demographic factors and assess for differences in clinical outcomes reported. RESULTS: Of the 5832 patients hospitalized with orbital cellulitis, 330 (5.7%) were in the corticosteroid group and 5502 (94.3%) were in the noncorticosteroid group. Patients in the corticosteroid group were older, had more severe illness, and received broad spectrum antibiotics. In adjusted analyses, corticosteroid exposure was not associated with differences in length of hospital stay, need for surgical intervention, ICU admissions, emergency department revisits, 30-day hospital readmissions, or hospital costs. Restricting the analysis to only those patients who received broad spectrum antibiotics did not change the findings. CONCLUSIONS: Early use of systemic corticosteroids in hospitalized children with orbital cellulitis is not associated with improved clinical outcomes. Use of corticosteroids in hospitalized children with orbital cellulitis should be discouraged outside of clinical trials.

Orbital Cellulitis in Children: Experience of the Pediatric Service at Mohammed v Military Hospital

Background: Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the vital and functional prognosis. This study aimed to analyze the epidemiological, therapeutic and evolutional aspects of orbital cellulitis cases treated at the pediatric service at Mohamed V military hospital. Patients and methods: retrospective study including all the children aged between 1 month and 15 years treated for orbital cellulitis at the pediatric service of the Mohamed V Hospital over a period of 3 years (1st January 2016-31st December 2019). Results: 24 cases of orbital cellulitis were gathered. Age varied between 1 month and 15 years with a median of age of 6. years. Feminine predominance (58%) was noted . The disease mainly involved the sinus (32%).Clinically, fever was present in 10 patients (41%),palpebral edema was universal, proptosis was noted in 5 cases(20.8%),chemosis and ptosis were noted in 4 cases(16.6%),bacteriological testing identified micro-organisms in 3 cases. An orbital CT scan was performed in all cases of our study, showing preseptal cellulitis in 14 cases (58.3%), orbital cellulitis in 3 cases(12.5%),and orbital abscess in 7 cases. The medical treatment consisted of ceftriaxone, metronidazole and aminoside or amoxicilline clavulanic acid, corticosteroid therapy prescribed in 5 cases. Surgical treatment was indicated in 3 patients. The outcome of All cases was favorable. Conclusion: The majority of our cases had a positive evolution highlighting the advantage of an early diagnosis, and adapted antibiotic and a multidisciplinary patient care making the need for surgery rarely necessary.

Necrotic Uveal Melanoma Mimics Orbital Cellulitis: A Review

<b><i>Background:</i></b> Uveal melanoma is the most common primary intraocular malignancy in adults, often resulting in painless vision loss. We report a case of necrotic uveal melanoma presenting with orbital inflammation mimicking orbital cellulitis and present a comprehensive review of the literature and tabulation of reported cases. <b><i>Summary:</i></b> Our review found 44 published reports of spontaneously necrotic uveal melanoma involving 55 patients. Of these reports, 26 patients (47%) presented with orbital cellulitis. Presenting symptoms of necrotic uveal melanoma with orbital cellulitis included proptosis (82.8%), pain (80.7%), vision loss (61.5%), and restricted extraocular movements (46.2%). <b><i>Key Messages:</i></b> Uveal melanoma can rarely mimic orbital cellulitis. Autoinfarction and tumor necrosis causes secondary orbital inflammation. Intraocular malignancy must remain in the differential for patients with orbital inflammation and vision loss.