Orbital Lymphoma Presenting As Recurrent Orbital Cellulitis: A Diagnostic Challenge

Area of Science:

• Ophthalmology
• Oncology
• Radiology

Background:

• Orbital cellulitis is an infection behind the orbital septum.
• Elderly patients with recurrent, culture-negative orbital cellulitis require thorough investigation.

Observation:

• A 71-year-old female presented with recurrent right orbital cellulitis.
• Initial CT and MRI suggested meningioma or osteomyelitis, but treatment was ineffective.
• A subsequent CT revealed a soft tissue lesion with bony erosion, leading to biopsy.

Findings:

• Histopathology initially showed chronic inflammation, later revised to high-grade B-cell lymphoma.
• The patient's symptoms did not fully resolve with standard orbital cellulitis treatment.
• The final diagnosis was orbital lymphoma mimicking orbital cellulitis.

Implications:

• Orbital lymphoma can present as orbital cellulitis, especially in the elderly.
• Failure to respond to conventional treatment warrants suspicion of underlying malignancy.
• Clinicians should consider orbital lymphoma in the differential diagnosis of recurrent, culture-negative orbital cellulitis.