Orbital Lymphoma Masquerading as Orbital Cellulitis

Abstract

Background. Orbital lymphomas are primarily non-Hodgkin type and can originate from the eyelids, extraocular muscles, soft tissue orbital adnexa, conjunctiva, or lacrimal glands. Orbital malignancies often represent a diagnostic dilemma for clinicians given their varying and atypical presentations. Objective. To report a case of orbital lymphoma mimicking orbital cellulitis. Case. A 66-year-old male patient presented with sudden onset of painful proptosis with visual impairment in the left eye for 15 days. On ocular examination, best-corrected visual acuity was 6/12 in the right eye and 2/60 in the left eye, abaxial proptosis with hypertropia, swollen and erythematous eyelids, restricted extraocular movement in all cardinal position of gaze, conjunctival congestion with chemosis and tortuous vessels, sluggish pupillary reaction, and chorioretinal folds in the inferior quadrants. The case was diagnosed as left eye orbital cellulitis, and the patient was treated with broad-spectrum intravenous antibiotics and oral steroids. No clinically discernible response was noted despite 7 days of antibiotics and steroids. Contrast-enhanced computed tomography (CECT) orbit showed features suggestive of orbital lymphoma involving the ipsilateral maxillary and ethmoid sinuses. ENT consultation with diagnostic nasal endoscopy and biopsy was done. Histopathological reports showed features of non-Hodgkin lymphoma. Conclusion. Orbital malignancies masquerading as orbital cellulitis can pose a diagnostic dilemma. A multidisciplinary approach involving ENT consultation, radiological investigation, and pathological sampling can help achieve a timely diagnosis and appropriate management.

Exophthalmos it’s not always a Cellulitis: Orbital Lymphoma Case Report

“…Vision impairment can be caused by optic nerve infiltration or compression through mass effect. Sometimes clinical presentation can be misleading especially when symptoms overlap with those of orbital cellulitis like in our case [6].…”

Orbital B-cell Lymphoma Masquerading As Dry Eye Disease

“…Several studies have reported the development of EMZL in patients with rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus. Infections with one of several infectious organisms have been associated with the development of EMZL, including Helicobacter pylori in gastric EMZL, Borrelia burgdorferi in skin EMZL, Chlamydia psittaci (C. psittaci) in orbital cell lymphoma, and hepatitis C virus in ocular EMZL [3,[5][6][7]. Previous studies have shown the resolution of gastric EMZL with the use of antibiotics, leading to the use of doxycycline as a treatment option for ocular EMZL.…”

“…Testing for antibodies against CD3, CD5, CD20, and CD79α to identify a lymphoma is either of B-cell or T-cell origin [ 3 ]. Additional testing to further categorize the lymphoma can also include identifying antibodies against BCL2, BCL6, CD10, CD23, CD30, Cyclin D-1, MUM-1, and κ and λ light chains [ 3 , 6 ]. A PET scan adds utility in checking for metastatic spread [ 1 ].…”

Predicting the prognosis of primary orbital lymphoma by clinical characteristics and imaging features

“…Unilateral orbital involvement, a combination of multiple therapies, and homogeneous enhancement of lesions were all associated with better outcomes. Unilateral orbit involvement was commonly found in the primary orbital lymphoma, especially for EMZL and diffuse large B-cell lymphoma, while patients with bilateral orbits involved were mainly with mantle cell lymphoma [1,9] . In this study, 21 patients had bilateral orbits involved, accounting for 20.2% of all patients, which was higher than reported by previous studies.…”