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Worsening Preseptal Cellulitis With an Orbital Abscess and Intracranial Extension in a Pediatric Patient
Taner B Celebi1, Ahmad Shamulzai2, Hadi Dahhan3
1Family Medicine, Northwell Health, Plainview, USA.
Insights
A pediatric case of preseptal cellulitis rapidly advanced to a subperiosteal orbital abscess and intracranial extension, necessitating surgical intervention. This underscores the critical need for prompt escalation of care in complex pediatric orbital infections.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Neurosurgery
Background:
- Preseptal cellulitis, an infection of the eyelid and periorbital tissues, can rarely progress to severe orbital complications.
- Orbital subperiosteal abscesses and intracranial extension represent significant pediatric emergencies requiring prompt diagnosis and management.
Observation:
- A 12-year-old male presented with preseptal cellulitis that worsened despite initial oral antibiotic treatment.
- The patient developed a subperiosteal orbital abscess with intracranial extension, evidenced by imaging showing multiple abscesses and a hematoma.
Findings:
- Despite outpatient antibiotic therapy, the patient required hospitalization and surgical intervention, including drainage of orbital and epidural abscesses.
- Imaging confirmed a mass effect on the globe and extraocular muscles due to the abscesses and hematoma.
Implications:
- This case emphasizes the potential for rapid progression of preseptal cellulitis to life-threatening orbital and intracranial infections.
- Timely escalation of care, including surgical drainage and multidisciplinary management, is crucial for favorable outcomes in complicated pediatric orbital infections.
Abstract:
This case presents a 12-year-old male patient diagnosed with preseptal cellulitis that progressed to a subperiosteal orbital abscess and eventually intracranial extension, despite outpatient antibiotic therapy. Initially treated with oral antibiotics for left eyelid swelling and pain, his condition worsened, prompting hospital admission and eventual surgical intervention. Imaging revealed multiple abscesses and a hematoma, causing mass effect on the globe and extraocular muscles. Despite aggressive medical management, surgical drainage was required, including a craniotomy for drainage of an epidural abscess. This case highlights the importance of timely escalation of care when complications arise from preseptal cellulitis.
