Orbital Pseudotumor Masquerading as Orbital Cellulitis

Author(s): Renis Qamo, Esilda Trushaj, Ermal Simaku

A 55-year-old albanian male was referred to the Ophtalmology Department in Mother Theresa University Hospital Tirana, with blurried vision, painful proptosis, limitied eye movements diplopia and chemosis of the right eye for three days. Two years ago he was diagnosed with orbital cellulitis. Over the next 72 hours, he did not clinically improve as it was expected. a diffuse infiltrative mass of orbital muscles and fat on the right eye with exophtalmy of this side that suggested for infiltrative tumor. Based on the results of radiology, it was required biopsy. Histopathology revealed the presence of lymphocites, plasma cells, myofibrolastic cells and collagen, with diagnose of inflammatory chronic moderated lesion. Given the negative workup, the presentation was determined to be consistent with idiopathic orbital inflammation via a diagnosis of exclusion. Therefore, the patient was treated with intravenous steroids that produced pronounced improvement within 24 hours. The patient was discharged in improved condition with a prednisone taper and ophtalomoly follow-up. Orbital pseudotumor if often misdiagnosed as orbital cellulitis, because of the similar presentation. It is important to consider differential diagnose when the initial diagnose and treatment does not progress as we expect.