<p>Orbital cellulitis clinically mimicking rhabdomyosarcoma</p>

Abstract

IntroductionProptosis in children with acute-onset accompanied by signs of inflammation is commonly caused by orbital cellulitis, however, the possibility of rhabdomyosarcoma should always be considered by the clinician. This is a case report of a five-year-old boy presenting with an acute-onset of proptosis without a history of trauma and systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital rhabdomyosarcoma.PurposeTo report a case of orbital cellulitis that clinically and radiologically mimics rhabdomyosarcoma.Case presentationA five-year-old boy presented with rapid-onset proptosis, periorbital edema, pain and visual loss in the left eye for two weeks without a history of trauma, upper respiratory tract infection, sinusitis or immunosuppression. Our clinical differential diagnosis includes rhabdomyosarcoma and orbital cellulitis. Complete blood count reveals a leukocytosis. Multislice computed tomography (MSCT) scan shows lesions involving the lateral orbit and the retro bulbar space. Antibiotics combination and adjunct anti-inflammatory intravenously shows excellent clinical resolution.ConclusionsThe study demonstrates difficulty in differentiating acute orbital cellulitis from rhabdomyosarcoma based on clinical findings. In addition, the case highlights that antibiotic combination of cephalosporin and aminoglycosides together with an adjuvant corticosteroid as an anti-inflammatory was effective in the case of acute orbital cellulitis.

Orbital rhabdomyosarcoma in a 19-year-old male patient: A case report and literature review

“…All in this case, the lesion is located in extraconal space; some diagnoses may be listed besides RMS such as orbital cellulitis, idiopathic orbital inflammation, capillary hemangioma, lymphangioma, Langerhans cell histiocytosis (LCH), and lymphoma. Orbital cellulitis which is a common cause of proptosis in children is often misdiagnosed as orbital RMS because of mimic clinical symptoms [10] . However, the absence of systemic symptoms like fever and lethargic behavior is more indicative of orbital RMS.…”

Causas infrecuentes de proptosis aguda dolorosa. Reporte de casos

“…Otras afecciones, como la trombosis de la vena oftálmica superior y las metástasis del seno cavernoso, son menos frecuentes, pero no improbables. El diagnóstico diferencial mediante la clínica resulta difícil, sobre todo cuando no hay antecedente de trauma ni de infección 3,[6][7][8] , y en estos casos la RM es la herramienta más sensible y específica [8][9][10][11] . La primera paciente que aquí reportamos tuvo un cuadro que sugería patología orbitaria, con una presentación aguda, presuntamente de naturaleza inflamatoria o vascular; sin embargo, los síntomas y los signos fueron insuficientes para presumir la causa, por lo que la RM tuvo un papel fundamental en el diagnóstico etiológico.…”

Rhabdomyosarcoma masquerading as orbital cellulitis

“…Amir et al . [ 4 ] revealed that orbital cellulitis can mimic RMS. However, a high degree of suspicion is essential in RMS diagnosis as the disease can be vision- and life-threatening.…”