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Langerhans cell histiocytosis mimicking preseptal cellulitis
Roxanne Kempster1, Ghee S Ang, Gavin Galloway
1Adnexal Service, Department of Ophthalmology Norfolk & Norwich University Hospital, Norwich, United Kingdom.
Insights
Recurrent preseptal cellulitis in a child may indicate Langerhans histiocytosis, a rare condition. Prompt investigation is crucial for accurate diagnosis and management of orbital lesions.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Pathology
Background:
- Preseptal cellulitis typically responds to antibiotics.
- Recurrent or persistent cases warrant further investigation beyond infection.
Observation:
- A 7-year-old girl presented with relapsing preseptal cellulitis.
- Imaging revealed a cystic preseptal lesion with lacrimal gland inflammation.
- Surgical excision exposed a subperiosteal hemorrhagic lesion.
Findings:
- Histopathology and immunohistochemistry confirmed Langerhans histiocytosis.
- Langerhans histiocytosis can present as an orbital lesion.
- Management varies with systemic involvement; localized lesions may resolve spontaneously or post-biopsy.
Implications:
- Highlights the importance of investigating underlying causes for refractory preseptal cellulitis.
- Emphasizes the need for prompt evaluation of relapsing or non-resolving pediatric orbital inflammatory signs.
- Underscores Langerhans histiocytosis as a differential diagnosis in pediatric orbital lesions.
Abstract:
A 7-year-old girl presented with signs of preseptal cellulitis that initially responded to antibiotics but then relapsed. Computed tomography scan revealed a cystic lesion in the preseptal tissues with associated soft tissue swelling and lacrimal gland inflammation. Anterior orbitotomy revealed a hemorrhagic-appearing lesion extending from the preseptal tissues subperiosteally along the roof of the orbit. The lesion was excised and histopathology and immunohistochemical staining confirmed a diagnosis of Langerhans histiocytosis. Management of this condition depends on the extent of systemic involvement, with single bony lesions usually pursuing a benign course and often spontaneously regressing or resolving following biopsy. This case serves to highlight that an underlying cause for preseptal cellulitis should be sought and if there are relapses or inadequately resolving signs of preseptal cellulitis, then prompt investigation to rule out other causes is required.