Manifestations of fungal cellulitis of the orbit in children with neutropenia and fever.

PURPOSE: To delineate clinical manifestations of fungal orbital cellulitis in immunocompromized patients.

METHODS: The charts of 7 pediatric patients with fungal orbital cellulitis treated at a tertiary children's cancer hospital were reviewed retrospectively for histologically confirmed fungal sinusitis with associated orbital cellulitis. Patients underwent CT and/or MRI of the orbits, sinuses, and brain; surgery; and therapy with antifungal medications. Main outcome measures were presenting signs and patient survival.

RESULTS: Twenty-four patients with fungal sinusitis were identified, 7 of whom (4 months to 15 years of age) had documented orbital fungal cellulitis. All 7 patients presented with neutropenia and fever. Presenting symptoms included edema of the upper eyelid (n=4), headache (n=1), and facial pain (n=1). One patient was asymptomatic. Although antifungal therapy was initiated within 24 hours of presentation, disease progressed, and 5 patients eventually died of their infections.

CONCLUSIONS: Because fungal orbital cellulitis can be fatal even if detected early in patients who are immunocompromised, ophthalmologists and otolaryngologists should be alert to the disease's subtle clinical manifestations.