A Case of Sweet's Syndrome Presenting as Orbital Cellulitis

Mi Sun Sung

Purpose: To report a case of Sweet's syndrome presenting as orbital cellulitis

Method: A 72-year-old woman presented to the emergency department with the acute onset of eyelid swelling, headache, malaise, and fever. On examination, her left eyelid was erythematous and swollen with vesicles. Ophthalmologic examination of the left eye showed conjunctival injection, chemosis, and moderate anterior chamber reactions with increased intraocular pressure. Laboratory investigations revealed a circulating neutrophilia. Both of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated. Orbital CT scan demonstrated marked infiltration of the left eyelid and superolateral orbit in a pattern suggesting orbital cellulitis. She was treated with intravenous cefotaxime and topical levofloxacin and fluorometholone eyedrops. The eyelid and intraocular lesions resolved slowly in 1 month. However, the patient returned after 1 month with a recurrence of similar lesions on the left eyelids. The lateral and inferior rectus muscles were severely enlarged and the adjacent soft tissue infiltrations were also noted on the repeat CT scans.

Result: Oral prednisone was started and the ocular inflammation and extraocular muscle enlargement resolved. Biopsy of ocular tissue was not decided because of the good response to treatment with systemic corticosteroids. We provisionally diagnosed the patient with orbital inflammation associated with Sweet's syndrome in MDS.

Conclusions: This ocular manifestation of Sweets' syndrome is unique presenting as orbital cellulitis and extraocular muscle enlargement.