Orbital cellulitis with posterior scleritis in a 13-year-old girl: A case report

Rationale: Clinical signs and symptoms of posterior scleritis vary and are easily confused with other diseases. Inflammation spreads anteriorly, involving the upper lid structures, causing lid swelling and simulating cellulitis. However, we report a case of orbital cellulitis with posterior scleritis and complications, with the aim of helping clinicians identify and treat early to prevent irreversible loss of vision. Patient concerns: A 13-year-old girl presented with pain in her right eye and an acute deterioration in vision. Diagnoses: The case was diagnosed as orbital cellulitis with posterior scleritis. Investigations revealed a raised C-reactive protein, erythrocyte sedimentation rate, and white cell count. Fundus examination revealed exudative retinal detachment, optic disc, and macular edema with a T-sign on B-scan ultrasound. Computed tomography of the paranasal sinuses and orbits reveals sinusitis and orbital inflammation. Interventions: Significant regression was observed in ocular symptoms and signs with antibiotic and steroid therapy. Outcomes: After 2 months, her vision improved significantly, but the baseline was still not reached. Lessons: Orbital cellulitis and posterior scleritis are often used as a differential diagnoses. However, this case showed that orbital cellulitis and posterior scleritis can occur simultaneously, especially in the presence of some obvious cause for or indicators of infection.