Posters

Retinoblastoma mimicking orbital cellulitis : a case report

Poster Details

First Author: E.Hala MOROCCO

Co Author(s):    B. Ibrahim   A. Amazouzi   L. cherkaoui              

Abstract Details

Purpose:

Retinoblastoma is a childhood retinal malignancy affecting approximately 9,000 new patients globally per year .In north Africa, it is the most important ocular malignancy, It is bilateral in about 25-35% of cases . Leukocoria and strabismus are the most common presenting signs. However, retinoblastoma can present with uncommon signs; hyphema, rubeosis iridis, neovascular glaucoma, hypopyon or orbital cellulitis, which all can signify advanced intraocular retinoblastoma needing rapid intervention . Any unexplained pediatric ophthalmologic presentation best includes retinoblastoma in the differential diagnosis, since misdiagnosis can be life threatening.

Setting:

HOPITAL DES SPECIALITES . RABAT . MOROCCO

Methods:

We report a 18-month-old child who was referred for three days of left periorbital swelling, purulent discharge ; the girl had two sisters who died of retinobastoma; father who was followed during his childhood for a retinoblastoma ; We suspected orbital cellulitis due to local signs of inflammation . An orbital CT demonstrated bilateral intraocular calcified tumors suggestive of retinoblastoma with left periocular highintensity area . The puffiness of eye reduced following 5 days of intravenous antibiotics. She received three cycles of chemotherapy, followed by enucleation of the left eye , and the pathological examination revealed retinoblastoma and extensive necrosis .

Results:

Orbital cellulitis is an infrequent (4-5%) presentation of retinoblastoma. Inflammation develops following tumor necrosis. Prednisolone along with antibiotics reduce inflammation . Presentation mimicking bacterial pre-septal cellulitis is known in malignancies including retinoblastoma and rhabdomyosarcoma. A calcified intraocular mass in such a case suggests the diagnosis of retinoblastoma. Imaging is required to confirm the diagnosis, access for local spread , metastasis and for trilateral retinoblastoma . Enucleation is a definitive treatment for retinoblastoma. Chemoreduction utilizes neoadjunctive chemotherapy to reduce the tumor volume and enable focal therapy .

Conclusions:

Orbital cellulitis remains a rare but serious presentation of advanced retinoblastoma and high suspicion of retinoblastoma and careful workup is essential to determine tumor extent. Lack of fever or leukocytosis in an otherwise unexplained pediatric orbital cellulitis points to high suspicion for retinoblastoma, especially when visualization is obstructed .

Financial Disclosure:

None