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BRIEF COMMUNICATION
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 25-26

Spill over preseptal cellulitis from temporalis intramuscular abscess: A rare presentation


Department of Ophthalmology, Mahatma Gandhi Mission Medical College, Kamothe, Navi Mumbai, Maharashtra, India

Date of Submission23-Jul-2013
Date of Acceptance11-Sep-2013
Date of Web Publication3-Dec-2013

Correspondence Address:
Pallavi Agrawal
601, Galaxy Shelter, Plot No. 109A, Sector 50E (New), Nerul West, Navi Mumbai - 400 706, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.122642

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  Abstract 

Predisposing causes of preseptal cellulitis includes sinusitis, impetigo, trauma, chronic dacrocystitis, and external hordeolum. Intramuscular abscess in temporalis muscle as a cause of preseptal cellulitis has never been reported in ophthalmic literature. We here report a case of preseptal cellulitis following temporoparietal cellulitis as a result of intramuscular (temporalis) abscess. Surgical removal of the abscess along with parenteral antibiotic therapy was the mainstay of the treatment in such a case.

Keywords: Intramuscular abscess, preseptal cellulitis, temporoparietal cellulitis


How to cite this article:
Agrawal P, Abidi N, Navadiya D. Spill over preseptal cellulitis from temporalis intramuscular abscess: A rare presentation. J Clin Ophthalmol Res 2014;2:25-6

How to cite this URL:
Agrawal P, Abidi N, Navadiya D. Spill over preseptal cellulitis from temporalis intramuscular abscess: A rare presentation. J Clin Ophthalmol Res [serial online] 2014 [cited 2020 Oct 22];2:25-6. Available from: https://www.jcor.in/text.asp?2014/2/1/25/122642

Preseptal cellulitis is a common infection of the eyelid and periorbital soft tissues that is characterized by acute eyelid erythema and edema. The common known causes of preseptal cellulitis are local spread of an adjacent sinusitis or dacrocystitis, from an external ocular infection, or following trauma to the eyelids. It is more common than orbital cellulitis, and more common in children than in adults. Preseptal cellulitis developing from a temporalis intramuscular abscess has never been reported in ophthalmic literature.

Case Report

A 12-year-old male presented with swelling on the right temporal region associated with fever. There was history of similar episode in the past. There is no history of trauma and no history of boils on the scalp. On examination, patient was febrile. Best corrected visual acuity in both eyes was 6/6 and N6 and ocular movements were full in all gazes. On local examination; there was tensed, tender swelling in the right temporal region measuring 5 cm × 7 cm with local rise in temperature [Figure 1]. Patient had limited mouth opening along with swelling both in upper and lower lid. Anterior and posterior segment of both the eyes was within normal limit.
Figure 1: Right temporal cellulitis with preseptal cellulitis

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Blood investigation showed leukocytosis, 14,100 cells/mm3 (normal 4,000-11,000 cells/mm3).

Magnetic resonance imaging (MRI) showed right temporoparietal cellulitis with preseptal invasion. A loculated thick-walled collection (abscess) was seen in right temporalis muscle [Figure 2].
Figure 2: Magnetic resonance imaging showing right temporoparietal cellulitis with preseptal invasion. A loculated thick-walled collection (abscess) was seen in right temporalis muscle

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Computed tomography (CT) scan revealed all the above with temporomandibular synovitis.

Empirical therapy with ampicillin and clavulinic acid (40 mg/ kg body weight) along with antipyretic and anti-inflammatory medication was started. Within 2 days the swelling subsided 50% and patient became afebrile. Jaw opening improved.

Two days after therapy, the loculated thick-walled abscess was excised from temporalis muscle. Culture of the pus showed Staphylococcus aureus.

Discussion

Amongst the cases of orbital cellulitis, preseptal cellulitis constitute 70% and postseptal cellulitis 30%.[1] Children constitute the majority of cases with preseptal cellulitis.

Most common cause of preseptal cellulitis is bacterial mostly Staphylococcal or Streptococcal.[2] Predisposing causes of preseptal cellulitis includes sinusitis, impetigo, trauma, chronic dacrocystitis, and external hordeolum.[3] Intramuscular abscess in temporalis muscle as a cause of preseptal cellulitis has never been reported in ophthalmic literature.

We here report a case of preseptal cellulitis following temporoparietal cellulitis as a result of intramuscular (temporalis) abscess. MRI played a major role in the diagnosis. Surgical removal of the abscess along with parenteral antibiotic therapy was the mainstay of the treatment in such a case. Surgical removal becomes important owing to the fact that similar episode had occurred in the child 1 month prior.

 
  References Top

1.Pandian DG, Babu RK, Chaitra A, Anjali A, Rao VA, Srinivasan R. Nine years' review on preseptal and orbital cellulitis and emergence of community-acquired methicillin-resistant Staphylococus aureus in a tertiary hospital in India. Indian JOphthalmol 2011;59:431-5.  Back to cited text no. 1
    
2.Bergin DJ, Wright JE. Orbital cellulitis. Br J Ophthalmol 1986;70:174-8.  Back to cited text no. 2
    
3.Rao VA, Hans R, Mehra AK. Pre-septal cellulitis — varied clinical presentations. Indian J Ophthalmol 1996;44:225-7.  Back to cited text no. 3
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