Pediatric viral orbital cellulites secondary to H1N1 infecti
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A 10-year-old boy was admitted in the pediatric unit with pneumonia. On the second day, he developed pain and swelling of the left eye (OS) and face. On examination, he was conscious, well-oriented, but febrile with a temperature of 102°F. Bedside visual acuity recorded in both eyes was counting fingers more than 3 m. Color vision was normal with normal pupillary reaction. Ocular examination revealed normal right eye (OD), but OS showed swollen tense eyelids with mechanical ptosis with hyperemia and edema of the left periorbital region and face.

There was no proptosis or presence of any orbital mass. Elevation was limited and painful while other extraocular movements were free and painless. The OS showed diffuse conjunctival congestion and chemosis, more in the superior fornix. Rest of the anterior segment and fundus examinations were within normal limits. Magnetic resonance imaging (MRI) of cranium and orbits showed pansinusitis involving both ethmoid and maxillary sinuses, left frontal sinus, and soft tissue thickening of ipsilateral face, preseptal extending into the postseptal area superiorly, involving the superior recti muscle.

Laboratory investigations revealed raised erythrocyte sedimentation rate and C-reactive protein with leucocytosis and neutrophilia. Blood culture and urine culture did not yield any growth. The child was nonresponsive to an empiric course of intravenous antibiotics including third-generation cephalosporins, piperacillin with tazobactum, metronidazole, and amikacin, despite which fever persisted and continued to rise up to 105°F. Meanwhile, nasopharyngeal and throat swabs were taken on the same day, that is, day 2 of admission and outsourced to a government-approved private laboratory (with 24 h facility) for real-time polymerase chain reaction (AgPath). Test was proven positive for H1N1 influenza virus. Following this, oseltamivir, a neuraminidase inhibitor, was started PO q12 h. There was significant reduction in temperature to 100°F within 24 h with simultaneous reduction in periorbital and hemifacial edema and hyperemia. Complete resolution of the periorbital swelling was seen in 5 days.

Source: Indian Journal of Ophthalmology

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