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Periorbital cellulits--a mistaken diagnosis!
Julia Fozard1, Nikila Pandya, Ashok Pulikot
1Department of Paediatrics, Maidstone Hospital, Dagenham, UK.
BMJ Case Reports
|June 13, 2012
Summary
A child with presumed preseptal cellulitis developed orbital cellulitis. Diagnosis was confirmed as cat scratch disease caused by Bartonella species after contact with kittens.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Orbital cellulitis is a serious condition requiring prompt diagnosis and treatment.
- Cat scratch disease (CSD) is a bacterial infection typically transmitted by cats, often presenting with lymphadenopathy and a skin lesion.
Observation:
- A 12-year-old girl presented with orbital swelling, granuloma, purulent discharge, and lymphadenopathy, initially treated as preseptal cellulitis.
- The condition progressed to orbital cellulitis despite broad-spectrum antibiotics, with restricted eye movements, chemosis, and hemorrhage.
Findings:
- Biopsy of the granuloma revealed Bartonella species, confirming the diagnosis of cat scratch disease.
- The patient had recent close contact with newborn kittens at home.
Implications:
- Early recognition of CSD is crucial, especially in pediatric orbital infections unresponsive to standard treatment.
- Prompt and appropriate antibiotic and steroid therapy can manage CSD, though visual outcomes may vary.
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