Bilateral Cryptocococcal orbital cellulitis associated with sinonasal cryptococcosis: a case report and review of the literature

Cryptococcus neoformans is an opportunistic fungal pathogen that typically affects the lungs and central nervous system. Orbital involvement is exceptionally rare and may mimic bacterial orbital cellulitis, resulting in delayed diagnosis and treatment. We report an 83-year-old immunocompromised man with poorly controlled diabetes and recent corticosteroid exposure who presented with rapidly progressive bilateral orbital cellulitis secondary to invasive cryptococcal infection with extensive sinonasal involvement. Despite broad-spectrum antimicrobial therapy, surgical intervention, and systemic antifungal treatment, the patient developed progressive orbital and systemic disease and ultimately died from multiorgan failure. A focused review of the literature identified only three previously reported cases of orbital or periorbital cryptococcosis. This case highlights the diagnostic challenges of orbital cryptococcal infection, the potential for contiguous spread from sinonasal disease, and the importance of early recognition and aggressive multidisciplinary management.