A case of orbital myositis secondary to orbital cellulitis in a child

A rare case of Enterococcus faecalis-induced orbital cellulitis and myositis

Orbital cellulitis is an infection of soft tissue behind the orbital septum. Common pathogens isolated include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. It is a straightforward diagnosis and usually responds to empirical treatment without any sequela. We report a case of orbital cellulitis caused by Enterococcus faecalis, which was complicated by myositis of levator palpebrae superioris. To the best of our knowledge, only one case report exists dating way back to 1986.

Unusual muscular injury in an infant with severe H1N1 infection

We report the first well-documented case of unilateral orbital myositis in an 8-month-old boy with life-threatening pandemic H1N1 infection. He presented with status epilepticus and hemodynamic failure associated with unusual right orbital myositis and acute rhabdomyolysis. Because of severe myolysis, metabolic screening was performed to exclude metabolic and genetic etiologies. After corticosteroid administration and symptomatic support, the disease evolution was favorable, without sequelae at hospital discharge. H1N1 influenza infection may be associated with multiple organ failure, and complicated by unusual muscle injury. The presence of intense myolysis should alert practitioners to potential metabolic and genetic etiologies.

Orbital myositis following streptococcal pharyngitis in a pediatric patient

BACKGROUND

Orbital myositis is a relatively rare ocular inflammatory disease. It is currently classified as an idiopathic orbital inflammatory disease, but has been associated with ocular and systemic disorders, including scleritis, rheumatoid arthritis, Crohn's disease, and systemic lupus erythematosis. Orbital myositis has also been associated with infectious disease such as streptococcal pharyngitis, viral upper respiratory infection, and Borrelia burgdorferi infection.

CASE REPORT AND DISCUSSION

This report documents treatment and imaging of a 13-year-old boy who had an episode of right-sided orbital myositis following streptococcal pharyngitis with anti-streptolysin-o (ASO) titer elevation to 1,188 IU/ml. Clinically, this patient demonstrated acute onset of marked restriction and mild under-action of the lateral rectus muscle of the right eye. Thickening of the lateral and medial recti was demonstrated on computed tomography. The mild orbital myositis was treated with oral nonsteroidal anti-inflammatory drug therapy. The nonconcomitant strabismus resolved approximately 7 weeks after initial presentation. General orbital inflammatory disease management and the association of upper respiratory tract infection with orbital myositis are discussed.

CONCLUSION

Orbital myositis is a distinct clinical entity that can occur after streptococcal upper respiratory infection, consisting of pain on ocular movement, localized swelling, restrictive strabismus, and inflammatory signs of the involved muscle(s).

Orbital myositis associated with Borrelia burgdorferi (Lyme disease) infection

OBJECTIVE

To report on the clinical findings in a patient with isolated left inferior rectus myositis associated with serologically confirmed Borrelia burgdorferi infection.

DESIGN

Interventional case report.

TESTING

Comprehensive clinical, laboratory, and imaging evaluation.

RESULTS

Contrast-enhanced computed tomography showed a swollen inferior rectus muscle with infraorbital soft tissue swelling in a patient with diplopia and prior symptoms consistent with manifestations of Lyme disease. Positive serum and cerebrospinal fluid antibodies to B. burgdorferi by enzyme-linked immunoassay were confirmed by Western blot, and the cerebrospinal fluid/serum antibody ratio was elevated. No alternative cause for orbital myositis was found, and treatment with antibiotics resulted in a complete recovery.

CONCLUSIONS

Orbital myositis should be added to the expanding list of ophthalmic manifestations of Lyme disease. Correct diagnosis and appropriate antibiotic therapy may reduce the likelihood of further neurologic or ophthalmologic sequelae.