Masquerading Orbital Abscess: A Case Report

Abstract

Any purulent collection in the orbit is known as an orbital abscess.1-2 It typically follows an infection of the orbital soft tissues (orbital cellulitis). Classic clinical findings include fever, erythema, proptosis, chemosis, ptosis, restriction of and pain with ocular movement, reduced visual acuity and an afferent pupillary defect.1-4 Orbital cellulitis/abscess is the most common cause of acute-onset proptosis in children.3,4 The differential diagnoses of orbital cellulitis include orbital trauma, for which there may not be a reliable history in children; nonspecific orbital inflammation; benign orbital tumors such as lymphatic malformation and hemangioma; as well as malignant tumors such as rhabdomyosarcoma, leukemia, and metastases.1 Rhabdomyosarcoma is the most common primary orbital malignancy in children.1,5,7,8 This makes it a particularly important differential of orbital cellulitis in addition to its classic presenting picture of sudden onset, rapidly progressive unilateral proptosis. It is associated with marked ocular adnexal inflammatory response in 60% of cases, thereby closely imitating orbital cellulitis.5-7 Herein, we report a case of orbital cellulitis with abscess that mimicked rhabdomyosarcoma in an eleven-year old boy with rapid-onset unilateral proptosis.