The place of case reports in medical literature: Periorbital cellulits – a mistaken diagnosis!

Case reports offer level IV evidence ranked well below randomised control trials and meta-analyses.

What role do case reports have then in the medical literature? Certainly, the report of adverse events, the opportunity to discuss diagnostic pitfalls, present novel methods of investigation and treatment and, of course, present cases of enormous interest and concern.

Over the next few weeks we hope to present a series of reports that illustrate these examples of the relevance of case reports in modern evidence based medicine. Here is the first…


A near miss

A 12 year old healthy girl presents with unilateral periorbital swelling, purulent discharge, pain in her jaw and palpable cervical lymphadenopthy. An initial diagnosis of preseptal cellulitis is made, but, in spite of a course of conventional broad spectrum antibiotics, the symptoms progress. A careful history and further investigation leads to a diagnosis of cat scratch disease and treatment is adjusted.

Seema Biswas

Periorbital cellulits – a mistaken diagnosis!