Neuroblastoma Presenting With Preseptal Cellulitis

Abstract

Neuroblastoma, a prevalent extracranial solid tumor commonly afflicting pediatric patients, exhibits a diverse spectrum of clinical presentations. Preseptal cellulitis, a childhood infectious ailment, typically demonstrates a favorable response to conservative antibiotic therapy. In this report, we present the case of a two-year-old female child with refractory preseptal cellulitis, ultimately leading to an unforeseen diagnosis of neuroblastoma. Early radiological assessment upon the onset of preseptal cellulitis serves the dual purpose of excluding severe complications and uncovering latent, rare pathologies when the initial antibiotic regimen proves ineffective.

Keywords: neuroblastoma metastases; nse; pediatric infection; periorbital abscess; periorbital cellulitis.

Figure 1. Clinical manifestations of the patient

(A) Left supraorbital swelling in the patient. Arrowhead indicates the left supraorbital swelling and redness on admission. (B–C) Radiological findings of the patient. Enhanced computed tomography (CT) of the head and neck identified supraorbital skin thickening with irregular subcutaneous fatty tissue concentration (B) and an enlarged left supraclavicular lymph node (C).

Figure 2. Clinical course presentation of the patient and disease dissemination in the patient by 123I-MIBG

(A) The patient experienced the recurrence of preseptal cellulitis 11 days after the discontinuation of antibiotics. No antibiotics were administered at the time of chemotherapy initiation. (B) 123I-MIBG scintigraphy of the patient. The arrows indicate the origin of neuroblastoma in the left adrenal gland, left orbital metastasis, and bone marrow infiltration. CLDM: clindamycin; CTX: cefotaxime; BT: body temperature; LDH: lactose dehydrogenase; CRP: c-reactive protein; ANT: anterior view; POST: posterior view; 123I-MIBG: 123I-metaiodobenzylguanidine.