Multiple panniculitis presenting as orbital cellulitis: a rare case report

Orbital cellulitis is an infectious inflammatory condition affecting structures surrounding the eye, posterior to the orbital septum. Panniculitis is an inflammatory disorder of subcutaneous fat, which may or may not be associated with vasculitis. Orbital cellulitis may be mimicked by non-infectious inflammatory conditions such as panniculitis, and these presentations are rarely reported in the literature.

A 65-year-old woman presented with pain and swelling in the left eye for 1.5 months, associated with redness and watering with no discharge. She also had multiple localized swellings on various body parts, including the right lateral flank and bilateral arms. On examination, approximately six lumps were found, with the largest located at the right lateral flank. Ocular examination of the left eye showed conjunctival congestion and edema and proptosis measuring 24 mm, with no ophthalmoplegia, restriction of eye movements, or visual disturbance. Initially, she was thought to have orbital cellulitis and was treated with topical and systemic antibiotics. Later, a biopsy of the left flank skin revealed panniculitis, and oral steroids were started, which led to signs of improvement.

Since orbital cellulitis and orbital panniculitis have similar features, it is challenging for clinicians to differentiate between these two conditions. Early detection of orbital panniculitis can help clinicians prevent unnecessary antibiotics, interventions, or surgery, and direct them to definitive management.

A diagnostic dilemma can occur when patients present with inflammatory conditions such as panniculitis. Non-infectious causes, such as panniculitis, should be considered in the context of patients presenting with subacute symptoms, a poor response to antibiotics, and associated systemic inflammatory lesions. A multidisciplinary approach involving clinicians from internal medicine and specialists in otolaryngology (ENT), rheumatology, and radiology can help with timely diagnosis and appropriate management in such cases.