Ocular adnexal lymphoma masquerading as orbital cellulitis in a child: A rare presentation!

ABSTRACT

Background: Extra-nodal natural killer/T-cell lymphoma (NKTCL) is a rare form of non-Hodgkin lymphoma (NHL). Few cases of Ocular adnexal T-cell lymphoma presenting as pre-septal cellulitis/orbital cellulitis has been reported in the literature. However, Extra Nodal NK/T cell non-Hodgkin lymphoma presenting as orbital cellulitis and also with multisystem involvement in the paediatric age group is a rare presentation and not reported earlier. Method(s) 13 years old male presented to us with weakness of left side with left facial palsy for 2.5 months and right eye severe proptosis and vision loss for 2 months. Initially, He was diagnosed with Orbital cellulitis and treated for the same from elsewhere. PET-CT showed FDG avid metabolic active largest soft tissue mass in left lung upper lobe encasing first rib, large active soft tissue mass in the periorbital area, right nasal cavity, right lobe of the thyroid, right kidney, pancreas head, scrotal area, multiple bony lesions. Further biopsy from rib mass revealed NK- T cell lymphoma. He was diagnosed with a rare case of NK/ T cell Non-Hodgkin Lymphoma with multisystem involvement. Initially, he responded to SMILE regimen of chemotherapy, but he developed white fluffy vitreous opacities in the left eye after 3 cycles, and before vitreous biopsy, he contracted COVID 19 infection. During COVID treatment he has received IV antibiotics and steroids. After recovery from covid illness, his vitreous opacities got disappeared suggestive of possible endophthalmitis rather than intraocular lymphoma. Later within two weeks, he succumbed to the disease. Result(s) Died with disease Conclusion(s) Our case highlights that ocular adnexal lymphoma can be a possible masquerade in cases of refractory lid swelling with erythema and induration and can present as orbital cellulitis with multisystem involvement. Copyright © 2022