Supplementary Material for: Preseptal cellulitis as the presenting sign of systemic inflammatory disease secondary to chikungunya virus: a case report

Introduction: Preseptal cellulitis in children, a leading cause of pediatric orbital inflammation, often masquerades as more severe systemic inflammatory conditions. Chikungunya virus is an arbovirus with a wide spectrum of systemic manifestations that can lead to potentially harmful complications within the nervous, cardiovascular, and renal systems if left undetected. A diagnostic challenge resides with its rare ophthalmic presenting feature of preseptal cellulitis. Herein, we described a case of Chikungunya virus masquerading as a preseptal cellulitis that led to a systemic inflammatory disease in a pediatric patient.

Case presentation: A 12-year-old male presented with unilateral preseptal cellulitis, with mildly elevated intraocular pressure, following a recent trip to Egypt. Visual acuity and color vision was preserved. Left knee effusion, cervical and inguinal adenopathy, and abdominal tenderness were noted. Imaging demonstrated bilateral preseptal cellulitis with an associated dacryoadenitis. Extensive multidisciplinary investigations determined the presence of positive Chikungunya IgM titers with a diagnosis of inflammatory pancreatitis and biopsy-proven acute kidney tubular injury. Clinical improvement was noted with supportive treatment.
Conclusion: Chikungunya virus can masquerade as a preseptal cellulitis in pediatric patients and lead to a multisystem inflammatory disease. Prompt clinical suspicion, diagnosis, and treatment can prevent harmful nervous, cardiovascular, and renal system complications.