Eczema herpeticum (EH) is a superimposed cutaneous viral infection that occurs in the context of preexisting dermatoses, most commonly atopic dermatitis (AD). It typically involves the face, neck, and upper trunk. Although ocular involvement is relatively uncommon, it may present diagnostic and therapeutic challenges and pose a significant risk to vision. We report a pediatric case of EH with severe ocular involvement in a young child with underlying AD. Despite early oral antiviral and antibiotic therapy, the condition progressed rapidly to orbital cellulitis. Clinical improvement was observed following escalation to intravenous antiviral therapy, addition of topical antiviral treatment, and broadening of antibiotic coverage, with subsequent full recovery. This case highlights the importance of early recognition, close monitoring, and timely escalation of treatment in EH with ocular involvement to prevent sight-threatening complications.

We reported a rare case of disseminated diffuse large B-cell lymphoma (DLBCL) initially presenting as refractory orbital cellulitis in a 53-year-old male. The patient presented with acute periorbital swelling, pain, and restricted ocular motility, unresponsive to broad-spectrum antibiotics. Magnetic resonance imaging (MRI) revealed extensive sinusitis with a peripherally enhancing medial extraconal orbital mass and adjacent bony erosions. A prompt functional endoscopic sinus surgery and histopathology revealed a poorly differentiated malignant neoplasm. Immunohistochemistry confirmed DLBCL, non-germinal center B-cell subtype. Systemic evaluation with whole-body MRI and fluorodeoxyglucose-positron emission tomography demonstrated widespread dissemination involving the lungs, gastrointestinal tract, adrenal glands, and skeleton. The patient was initiated on required chemoimmunotherapy with central nervous system prophylaxis and remains under oncology follow-up. This case highlights the diagnostic challenge posed by orbital lymphoma mimicking infectious orbital cellulitis and underscores the need for early imaging and tissue diagnosis in culture-negative, non-resolving cases. A high index of suspicion and multidisciplinary collaboration are essential for timely diagnosis and effective management.

Orbital compartment syndrome, a condition in which increased pressure within the orbit can cause permanent visual impairment, can be caused by infection or trauma. Orbital cellulitis is a spectrum of infection that can progress to abscess formation within the orbit, subsequently leading to orbital compartment syndrome. We describe the case of an immunocompetent pediatric patient who developed an orbital abscess from asymptomatic sinusitis, which led to orbital compartment syndrome. He received a lateral canthotomy and cantholysis followed by definitive management of his orbital abscess and experienced good visual outcomes. This case highlights the importance of checking intraocular pressures in patients presenting with orbital infections, and the need for swift intervention in cases of suspected orbital compartment syndrome.

A 38-year-old female, only known for beta-thalassemia minor trait, presented 3.5 weeks postpartum with six days of worsening right wrist pain and sepsis. Initial misdiagnosis resulted in delayed surgical debridement of her wrist after two months. Additionally, a concurrent orbital pre-septal cellulitis with different bacteria aided in the diagnosis of an underlying postpartum complement deficiency predisposing her to multiple infections with different organisms in the acute postpartum period. Follow-up at one year and eight years demonstrated significant functional limitations, reduced range of motion, and radiographic evidence of pan-carpal destructive arthropathy with fusion of the carpus. Septic arthritis is a surgical emergency; however, postpartum immunodeficiency is an unreported condition that must be recognized due to the risk of developing multisystem infections and may lead to delayed treatment with devastating sequelae.

Nontraumatic head and neck emergencies in children are common and often infectious, with overlapping and nonspecific clinical presentations that can delay accurate diagnosis. Imaging plays a critical role in distinguishing self-limited conditions from conditions requiring urgent intervention. This review provides an anatomically organized overview of pediatric orbital, sinonasal, oral cavity, deep neck, temporal bone, and skull base emergencies and foreign-body events. We highlighted the role of radiologists in emergent clinical decision-making, from appropriate modality selection (radiography, contrast-enhanced CT, MRI, and angiographic techniques) to the identification of key imaging findings that alter the management and recognition of common diagnostic pitfalls.

Orbital lymphangioma is a rare benign low-flow venous-lymphatic malformation that typically presents with slowly progressive proptosis in children. Acute inflammatory presentations mimicking orbital cellulitis are uncommon and may lead to diagnostic delay. We report the case of an 11-year-old girl presenting with acute left-sided facial swelling and proptosis following an upper respiratory tract infection. Initial management for presumed orbital cellulitis with intravenous antibiotic therapy was unsuccessful. Contrast-enhanced CT showed diffuse soft tissue infiltration without abscess formation, while MRI revealed a multiloculated cystic lesion with hemorrhagic components involving both intra- and extraconal spaces, consistent with orbital lymphangioma. The patient underwent 3 sessions of bleomycin-based sclerotherapy at 1-month intervals, with good tolerance and no complications. Progressive clinical improvement was observed, with complete resolution of proptosis and chemosis at 5 months and no recurrence at 1-year follow-up. This case highlights the key role of MRI in differentiating orbital lymphangioma from infectious processes and supports sclerotherapy as an effective minimally invasive treatment option.

Background and Clinical Significance: Bilateral carotid-cavernous fistulas are rare clinical entities characterized by heterogeneous clinical presentations and variable outcomes. Case presentation: We report the case of a 69-year-old woman with a three-month history of progressive bilateral conjunctival hyperemia, proptosis, intermittent diplopia, and a left eye abduction deficit. Her systemic history included long-standing arterial hypertension and previous thyroidectomy with stable substitutive therapy. Comprehensive ophthalmologic, neurologic, and endocrine evaluations excluded more common causes of orbital congestion, including thyroid eye disease, orbital cellulitis, cavernous sinus thrombosis, and idiopathic orbital inflammation. The patient denied any history of recent trauma. Digital subtraction angiography (DSA) confirmed a bilateral, low-flow, indirect Barrow type D carotid-cavernous fistula (CCF) supplied by dural branches of both the internal and external carotid arteries, with marked reflux into dilated superior ophthalmic veins. DSA was essential, as prior CT and MRI studies did not identify any vascular abnormalities. The patient was scheduled for transvenous embolization; however, during the follow-up she noted gradual improvement in her condition. Repeat pre-procedural angiography performed approximately two months later demonstrated complete spontaneous closure of all shunts, accompanied by full clinical resolution. Conclusions: Owing to the exceptional rarity of bilateral indirect CCFs and the added occurrence of spontaneous closure, this case expands the limited existing literature and emphasizes the diagnostic challenges and the need for individualized treatment timing supported by multidisciplinary evaluation in low-flow dural carotid-cavernous fistulas.

BACKGROUND Glaucoma drainage implants, including the Paul glaucoma implant, are widely used in the management of refractory glaucoma when medical therapy and conventional filtering surgery prove insufficient. Although associated with favorable outcomes, rare but serious postoperative complications such as endophthalmitis and panophthalmitis can occur, resulting in significant visual morbidity. CASE REPORT We describe the case of a 77-year-old man with chronic angle-closure glaucoma who developed acute panophthalmitis with orbital cellulitis 12 days following uneventful Paul glaucoma implant surgery. He presented with severe ocular pain, eyelid swelling, restricted ocular motility, and marked reduction in visual acuity to light perception. Clinical examination revealed pronounced anterior and posterior segment inflammation. B-scan ultrasonography showed dense vitreous opacities, shallow choroidal detachment, and ocular wall thickening. Computed tomography of the orbit confirmed associated orbital cellulitis with proptosis and extraocular muscle swelling. The patient underwent vitreous tap with intravitreal vancomycin, ceftazidime, and dexamethasone, along with intensive topical and systemic antimicrobial therapy. Despite an initial partial response, progressive inflammation required pars plana vitrectomy. Removal of the glaucoma drainage implant was not possible intraoperatively due to severe inflammation. Microbiological cultures remained negative throughout. With coordinated multidisciplinary management involving glaucoma, retina, and oculoplastic services, orbital inflammation gradually resolved, and visual acuity improved from light perception to 20/250 at final follow-up. CONCLUSIONS This case highlights the importance of close postoperative monitoring to ensure correct diagnosis and aggressive management of infections, preservation of globe integrity, and optimization of visual outcomes following glaucoma drainage device surgery.

We report the case of a 10-year-old male patient with bone marrow aplasia secondary to Fanconi anemia who was initially admitted for febrile purulent tonsillitis (no throat culture was performed before antibiotic initiation). Despite several courses of broad-spectrum antibiotic therapy, the clinical course was marked by persistent fever and progressive right-sided orbitofacial cellulitis. Imaging revealed extensive involvement of the right maxillary sinus with orbital extension. The appearance of a necrotic black palatal lesion (eschar) in the setting of profound immunosuppression is highly characteristic, if not pathognomonic, of invasive mucormycosis. Liposomal amphotericin B (5 mg/kg/day) was initiated; however, surgical debridement could not be performed due to severe thrombocytopenia (platelet count of 1,000/mm³). The patient subsequently developed septic deterioration requiring intensive care management and ultimately died. This report highlights the diagnostic challenges and the rapidly progressive course in a severely immunocompromised pediatric patient and emphasizes the importance of early recognition and prompt initiation of antifungal therapy, although management may remain limited in patients with profound cytopenia in whom surgical treatment is not feasible.