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Elevated Intraocular Pressure in Periorbital Sweet's Syndrome.

Jamie A Keen1, Mark D Fisher2, Caroline Y Yu1

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|March 9, 2023
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Summary

This case report highlights Sweet's syndrome, a rare neutrophilic dermatosis, presenting as severe periocular cellulitis. Prompt surgical intervention and medical management were crucial for preserving vision and treating this unusual presentation.

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Area of Science:

  • Ophthalmology
  • Dermatology
  • Pathology

Background:

  • Cellulitis around the eye can mimic serious conditions like necrotizing fasciitis or orbital compartment syndrome.
  • Immunocompromised status increases susceptibility to severe infections and inflammatory conditions.
  • Sweet's syndrome, or acute febrile neutrophilic dermatosis, typically presents with characteristic skin lesions and systemic symptoms.

Purpose of the Study:

  • To describe a rare case of Sweet's syndrome presenting as severe periocular cellulitis.
  • To emphasize the importance of urgent surgical and medical management in suspected orbital compartment syndrome.
  • To correlate clinical findings with histopathological analysis for accurate diagnosis.

Main Methods:

  • Clinical examination of a 66-year-old immunocompromised male with periocular cellulitis.
  • Urgent surgical debridement, lateral canthotomy, and cantholysis.
  • Ophthalmological assessment including intraocular pressure measurement.
  • Histopathological analysis of eyelid skin biopsy.

Main Results:

  • The patient presented with severe periocular erythema, edema, induration, and elevated intraocular pressure (35 mm Hg).
  • Surgical intervention and antihypertensive eye drops normalized intraocular pressure.
  • Histopathology revealed extensive neutrophilic infiltrate, confirming Sweet's syndrome.

Conclusions:

  • Sweet's syndrome can present atypically with severe periocular inflammation mimicking orbital emergencies.
  • Multidisciplinary approach involving ophthalmology, surgery, and dermatology is vital for diagnosis and management.
  • Early recognition and treatment are essential to prevent vision loss and complications.