Orbital cellulitis is a clinical diagnosis. Once the diagnosis is made, an empirical antibiotic is started, and in most cases, the clinical improvement can be observed within 24-48 hours. We discuss treatment options in managing orbital cellulitis in a 34-year-old male in which no improvement was seen despite being started on empirical broad-spectrum antibiotic. Patient had a prior history of being bitten by an insect in the left upper eyelid while doing gardening about 5 days prior to admission. The patient developed left orbital cellulitis a few days following the insect bite. Patient was started empirical broad-spectrum antibiotic immediately, but no improvement observed. Culture and sensitivity taken from the upper eyelid grew methicillin-resistance Staphylococcus aureus (MRSA) which was sensitive to vancomycin. Patient was treated with intensive fourteen days of intravenous vancomycin. The infection resolved as evidenced by clinical improvement and reduction of white blood cells count.
Myeloid sarcoma (MS) is an uncommon type of malignancy, and its diagnosis is comparable to acute myeloid leu- kaemia (AML). In the rare circumstances in which MS does present without AML, it is known as MS de novo. We report a case of a 10-month old child who presented with bilateral proptosis and a pelvic mass due to synchronous primary MS de novo. She was initially misdiagnosed with neuroblastoma, which has this typical presentation. The histopathological result from the biopsy of the orbital mass also showed a small blue round cell tumour (SBRCT) as seen in cases of neuroblastoma. However, the diagnosis of MS was confirmed using immunohistochemistry (IHC) from the orbital biopsy specimen, which usually plays a major role in the diagnosis of orbital tumours and as a prog- nostic indicator. Our patient remains in clinical remission two years after antileukemic treatment, with no relapse or progression to AML.