Idiopathic orbital inflammatory syndrome treated initially as orbital cellulitis
Author: Minnan Al-Khafaji
Base Hospital / Institution: Royal London Hospital
ePoster presentation
Abstract ID: 24-299
Purpose
The diagnosis of acute unilateral orbitopathy can be challenging and includes infective, inflammatory and neoplastic causes. We present here a case of idiopathic orbital inflammatory syndrome (IOIS) treated initially as orbital cellulitis.
Methods
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Results
An 81-year-old female with a background of type 2 diabetes mellitus, chronic kidney disease and atrial fibrillation was referred to a tertiary centre after a diagnosis of ‘periorbital cellulitis’, not improving with oral antibiotics. Examination findings showed unilateral lid oedema, proptosis, erythema, chemosis and an acuity of 6/7.5. CT-scan revealed extensive soft tissue swelling and fat stranding surrounding the right eye which extended retrograde to the orbital septum to involve the retro-orbital structures in keeping with orbital cellulitis. Despite 48 hours of broad-spectrum intravenous antibiotics, the clinical signs worsened. Both inflammatory markers and white cell count were normal and she remained afebrile. She was discussed in a neuro-radiology MDT which re-reported the CT scan as showing a right lacrimal gland enlargement with ill-defined abnormal tissue in the superior extraconal compartment, not in keeping with a lymphoproliferative process but more likely with an underlying inflammatory or granulomatous process with an advisory MRI orbits + contrast. The inflammatory markers remained normal with persisting symptoms and she was started on high-dose oral prednisolone. Her symptoms began to improve within 5 days of starting the steroids and a decision was made to taper this down over the 6 weeks. Immunoglobulin and auto-immune screens were all negative. She was discharged 4 days following admission.
Conclusion
This case highlights the importance of an exhaustive work-up, inclusive of systemic investigations, in order to differentiate between infective and inflammatory aetiologies. Failure to respond to initial treatment (such as antibiotics) should prompt re-evaluation and consideration of other diagnoses, such as severe IOIS, which whilst potentially sight-threatening is highly responsive to high-dose systemic steroids.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Sahana | Kodandaramaiah | Royal London Hospital |
| Nikhil | Cascone | Royal London Hospital |
