Orbital cellulitis presenting as persistent fever in a neonate after inappropriate caregiving practices

Neonatal orbital cellulitis is an uncommon but serious infection that can lead to an orbital abscess, often requiring surgical intervention. We report a rare case of a term neonate presenting on day 20 of life with persistent fever and irritability without initial orbital signs. Blood culture revealed methicillin-resistant Staphylococcus aureus (MRSA), and intravenous vancomycin was initiated. By day 3 of admission, the infant developed periorbital swelling; imaging confirmed a retro-orbital abscess. With timely antibiotic therapy, the infection resolved without the need for surgical drainage. Notably, there was a history of inappropriate infant care practices, including bottle feeding and external application of native substances, which may have contributed to the infection. This case underscores the importance of considering orbital infections in neonates with sepsis of unclear origin, initiating early MRSA-targeted therapy and promoting good neonatal care practices. Conservative management may be successful in uncomplicated cases with early diagnosis and close monitoring.