Persistent Eyelid Swelling and Rash Unresponsive to Initial Therapy: An Atypical Inflammatory Case
Abstract
Eyelid inflammation with swelling and rash can have a variety of etiologies that range from completely benign to time-sensitive and vision threatening. Common causes of periorbital edema include autoimmune conditions, infectious processes, and allergic reactions that can present similarly and delay treatment. Careful attention is needed to examine medication timing, symptom progression, patient history, and context to thoroughly evaluate differentials and guide patient care. We present a pediatric case of persistent eyelid inflammation, highlighting the need for collaborative problem-solving in an atypical rash. An 11-year-old female with a medical history of rheumatoid arthritis presented to the emergency department due to periorbital swelling and rash. Her symptoms began 4 days after her latest methotrexate and Humira infusion and progressed despite antibiotic, antiviral, and antifungal medication prescribed by her pediatrician. The patient denied any other symptoms and review of systems was unremarkable aside from recent oral lesions. Due to the proximity to the eyes and the possibility of a resistant pathogen, both ophthalmology and infectious disease consultations were made. After extensive laboratory workup and a normal eye exam, drug induced lupus and erythema multiforme became the leading differentials. Her rash and swelling resolved by the time she followed up with her outpatient rheumatologist who decided to continue her infusions, preferring the diagnosis of erythema multiforme. This case illustrates the critical nature of timely and thorough care. Collaboration among specialties reduced the risk of vision loss, worsening symptoms, or delayed treatment. While erythema multiforme became the top differential, it was imperative to rule out drug induced lupus so that the patient could continue the infusions for her rheumatoid arthritis. The case illustrates the importance of a broad differential containing both immune-mediated and medication-mediated etiologies when persistent periorbital edema and rash remain refractory to initial treatment.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
63
Presentation Type
Poster
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Brent Aebi
Persistent Eyelid Swelling and Rash Unresponsive to Initial Therapy: An Atypical Inflammatory Case
Culp Ballroom 316
Eyelid inflammation with swelling and rash can have a variety of etiologies that range from completely benign to time-sensitive and vision threatening. Common causes of periorbital edema include autoimmune conditions, infectious processes, and allergic reactions that can present similarly and delay treatment. Careful attention is needed to examine medication timing, symptom progression, patient history, and context to thoroughly evaluate differentials and guide patient care. We present a pediatric case of persistent eyelid inflammation, highlighting the need for collaborative problem-solving in an atypical rash. An 11-year-old female with a medical history of rheumatoid arthritis presented to the emergency department due to periorbital swelling and rash. Her symptoms began 4 days after her latest methotrexate and Humira infusion and progressed despite antibiotic, antiviral, and antifungal medication prescribed by her pediatrician. The patient denied any other symptoms and review of systems was unremarkable aside from recent oral lesions. Due to the proximity to the eyes and the possibility of a resistant pathogen, both ophthalmology and infectious disease consultations were made. After extensive laboratory workup and a normal eye exam, drug induced lupus and erythema multiforme became the leading differentials. Her rash and swelling resolved by the time she followed up with her outpatient rheumatologist who decided to continue her infusions, preferring the diagnosis of erythema multiforme. This case illustrates the critical nature of timely and thorough care. Collaboration among specialties reduced the risk of vision loss, worsening symptoms, or delayed treatment. While erythema multiforme became the top differential, it was imperative to rule out drug induced lupus so that the patient could continue the infusions for her rheumatoid arthritis. The case illustrates the importance of a broad differential containing both immune-mediated and medication-mediated etiologies when persistent periorbital edema and rash remain refractory to initial treatment.
