(BMJ)—A previously well 16-year-old female presented with L eyelid swelling x3wk with no improvement after 2 courses of abx and worsening visual acuity in L eye. No hx of trauma, insect bites, fever, fatigue. Exam: L upper lid tender, fluctuant; restricted upgaze. Labs: unremarkable. What's the dx?
Rhabdomyosarcoma
Idiopathic orbital inflammatory syndrome
Aspergillosis
Orbital cellulitis
Dermoid cyst
You are correct. Imaging and bx confirmed rhabdomyosarcoma, the most common malignant orbital tumor in childhood. Although infxn is the most likely cause of an orbital mass, in the absence of raised inflammatory markers and a lack of response to abx, a dx of malignancy should be considered early. This patient was treated with chemo and radio-tx and has not had any recurrence.

BMJ 2015;350:h799

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STI

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RVVC

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PCR

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OTC

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