A 12-Month-Old Boy With Bilateral Facial Swelling and Proptosis

A 12-month-old healthy boy was seen at the outpatient ophthalmology clinic with gradually worsening bilateral temporal facial swelling and proptosis that developed in the setting of a recent bilateral ear infection 10 days prior. He was currently being treated with oral amoxicillin. His mother reported a recent decrease in appetite, decreased feeding, increased irritability, and near-constant crying.

On examination, he was inconsolable and crying. His pulse rate was 112 beats/min, blood pressure was 122/68 mm Hg, and temperature was 38.7°C. He had soft, bitemporal facial masses (Figure, A). He was proptotic and demonstrated a substantial change in his ocular appearance compared with photographs taken 4 weeks earlier that his mother brought for our review. He appeared to be orthophoric in primary gaze but had bilateral abduction deficits. His pupils were round and reactive, without an afferent pupillary defect. His anterior and posterior segment examination results were normal, without evidence of optic nerve edema or pallor. His pediatrician had obtained a complete blood cell count and head radiograph 10 days prior that were both normal.