More Than Meets the Eye: Orbital Swelling in an Adolescent with Sickle Cell Disease

Abstract

Periorbital swelling is a clinical presentation with a broad differential and potentially deleterious consequence. Causes range from benign, including allergic reaction, to vision- and life-threatening, including orbital cellulitis and orbital infarction. The recent climate of SARS-CoV-2 has further complicated this differential, as the virus poses broad clinical presentations with new manifestations reported frequently. Rapid identification of the underlying etiology is crucial, as treatment approaches diverge greatly. Here, we report the case of an African American adolescent male with a history of homozygous sickle cell anemia presenting to an inner city hospital with bilateral periorbital swelling amid the coronavirus pandemic. Differentials including orbital cellulitis, COVID-MIS-C, orbital inflammatory syndrome, Hoagland sign, and orbital infarction secondary to sickle cell crisis are contrasted. We contrast our case with 12 case reports of orbital infarction in the setting of sickle cell crisis within the past 10 years, highlighting how these presentations, along with commonly reported findings of orbital infarction, compare with our patient.

Role of Traditional Stroke Risk Factors Aiding in Prediction of Infarcts in Adult Patients With Sickle Cell Disease

“…Recurrent infarcts in the spleen result in functional asplenia, which upsurges the risk of infections, particularly from the encapsulated bacteria. 8 Overall, infarcts in various organs such as liver, kidneys, and lungs lead to chronic organ damage over time. 9 In particular, the neurological complications arising from SCD are consequentially devastating ranging from overt strokes to covert cerebral injuries including the silent cerebral infarctions and blood vessel damage.…”