Manifestations of fungal cellulitis of the orbit in children with neutropenia and fever.

OBJECTIVE

To delineate clinical manifestations of fungal orbital cellulitis in immunocompromized patients.

METHODS

The charts of 7 pediatric patients with fungal orbital cellulitis treated at a tertiary children's cancer hospital were reviewed retrospectively for histologically confirmed fungal sinusitis with associated orbital cellulitis. Patients underwent CT and/or MRI of the orbits, sinuses, and brain; surgery; and therapy with antifungal medications. Main outcome measures were presenting signs and patient survival.

RESULTS

Twenty-four patients with fungal sinusitis were identified, 7 of whom (4 months to 15 years of age) had documented orbital fungal cellulitis. All 7 patients presented with neutropenia and fever. Presenting symptoms included edema of the upper eyelid (n=4), headache (n=1), and facial pain (n=1). One patient was asymptomatic. Although antifungal therapy was initiated within 24 hours of presentation, disease progressed, and 5 patients eventually died of their infections.

CONCLUSIONS

Because fungal orbital cellulitis can be fatal even if detected early in patients who are immunocompromised, ophthalmologists and otolaryngologists should be alert to the disease's subtle clinical manifestations.