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Case Reports
. 2021 Sep 9:2021:8832783.
doi: 10.1155/2021/8832783. eCollection 2021.

Orbital Lymphoma Masquerading as Orbital Cellulitis

B D Chaurasiya  1 , Ganesh Agrawal  2 , Santosh Chaudhary  3 , Sangeeta Shah  3 , Anju Pradhan  4 , Poonam Lavaju  3
Affiliations
Case Reports

Orbital Lymphoma Masquerading as Orbital Cellulitis

B D Chaurasiya et al. Case Rep Ophthalmol Med. .

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.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Orbital cellulitis at presentation in the left eye (front and lateral view).
Figure 2
Figure 2
Conjunctival congestion with tortuous vessels in the left eye.
Figure 3
Figure 3
Blurred disc margin with chorioretinal folds in the left eye.
Figure 4
Figure 4
USG B-scan: homogenous mass distorting the globe inferiorly (as shown by an arrow) in the left eye.
Figure 5
Figure 5
CECT-orbit: contrast enhanced intraorbital mass involving the optic nerve (as shown by an arrow in (a)) and the mass extending to sinonasal cavity (as shown by an arrow in (b)).
Figure 6
Figure 6
Endoscopic biopsy specimen (H&E x20). Microphotograph shows the H&E-stained section showing diffuse proliferation of atypical cells with apoptotic bodies.
See this image and copyright information in PMC

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