A 62-year-old woman with periorbital and preseptal edema and erythema

We report the case of a 62-year-old woman with a past medical history of leukemia, stem cell transplant, donor lymphocyte infusion, meningioma, and a prior episode of Sweet syndrome (SwS). She presented with progressive erythema, crusting, and edema in the preseptal and periorbital regions of her left eye. After initial treatment for presumed preseptal cellulitis with broad-spectrum antibiotics, the patient's symptoms worsened and became bilateral. The absence of systemic infectious signs and lack of clinical improvement raised suspicion for an alternative etiology. Given her history of SwS, a trial of systemic corticosteroids was initiated, resulting in a rapid clinical improvement. The diagnosis of cellulitis was subsequently rejected, and an ophthalmologic manifestation of SwS was suspected. This case highlights the importance of considering noninfectious inflammatory etiologies in patients with atypical or antibiotic-refractory periorbital symptoms-particularly in patients with a relevant medical history.