Abstract ID: 26-418
When Periorbital Cellulitis Is Not Cellulitis: Thinking Outside the Orbit
Author: Dana Awwad Base Hospital / Institution: Royal Stoke University Hospital
Presentation Type: ePoster Presentation
Purpose
Periorbital cellulitis typically responds rapidly to antibiotic therapy. Persistent or atypical periorbital swelling should prompt investigation for inflammatory, autoimmune, or neoplastic mimics.
Methods
A 74-year-old male presented with progressive left periorbital swelling and erythema, initially treated as orbital cellulitis with antibiotic courses without improvement. Associated infraorbital anaesthesia raised suspicion for an alternative diagnosis. Medical history included chronic lymphocytic leukaemia (diagnosed 2002, not on treatment), hypertension, type 2 diabetes mellitus, and previous functional endoscopic sinus surgery.Examination demonstrated tense erythematous inferior periorbital swelling without ophthalmoplegia, relative afferent pupillary defect, or clinically evident proptosis. Sac washout was patent without punctal discharge.
Results
CT imaging showed periorbital soft tissue inflammation without abscess or mass. MRI favoured orbital inflammatory disease/pseudotumour rather than infection.
Blood results showed elevated inflammatory markers and raised ACE levels, with negative autoimmune and infectious screening including ANA, IgG4 and QuantiFERON. Initial lacrimal sac and conjunctival biopsies showed acute and chronic inflammatory changes without malignancy or lymphoproliferative disease.
The disease progressed to septal perforation, prompting repeat biopsies which again demonstrated non-specific chronic inflammation. Oral prednisolone produced marked clinical improvement, and methotrexate was subsequently commenced under rheumatology.
Conclusion
This case highlights the diagnostic challenges of persistent periorbital inflammation mimicking cellulitis. Failure to respond to antibiotics, septal perforation and steroid responsiveness raised suspicion for granulomatosis with polyangiitis despite repeatedly inconclusive histopathology. Early multidisciplinary assessment, advanced imaging, and timely immunosuppressive therapy may prevent progressive tissue damage even when diagnostic uncertainty remains.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Sohail | Ahmed | Royal Stoke University Hospital |