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Ringworm causing childhood preseptal cellulitis
P S Rajalekshmi1, Sarah L Evans, Claire E Morton
1Department of Ophthalmology, H. M. Stanley Hospital, St. Asaph, United Kingdom.
Insights
Dermatophyte fungal infection caused a child's eyelid swelling, unresponsive to antibiotics. Prompt diagnosis and antifungal treatment led to complete resolution, highlighting the need for broader differential diagnoses.
Area of Science:
- Ophthalmology
- Mycology
- Pediatrics
Background:
- Preseptal cellulitis is typically a bacterial infection.
- Standard antibiotic therapy is the first line of treatment for preseptal cellulitis.
Observation:
- A 4-year-old girl presented with a week of left upper eyelid redness and swelling, unresponsive to topical and oral antibiotics.
- Examination revealed a diffuse, erythematous, tender lesion with ulceration, bleeding, discharge, and vesicles, alongside a maternal rash suggestive of fungal infection.
- Microbiology confirmed fungal hyphae from the Dermatophyte group.
Findings:
- Dermatophyte infection (ringworm) was identified as the cause of the preseptal cellulitis.
- Treatment with oral Griseofulvin resulted in complete resolution of the eyelid lesion.
Implications:
- This case underscores the importance of considering fungal infections, specifically Dermatophytes, in cases of preseptal cellulitis that do not respond to antibiotics.
- It highlights the need for a broader differential diagnosis in pediatric eyelid infections.
- Early identification and antifungal treatment are crucial for successful outcomes in atypical preseptal cellulitis cases.
Abstract:
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.