CASE PRESENTATION Initial Presentation and History A previously healthy 9-year-old boy presented to the emergency department for evaluation of swelling

A previously healthy 9-year-old boy presented to the emergency department for evaluation of swelling of the right eye, which had been present for 24 hours. His parents reported that he had an antecedent history of nighttime cough, frontal headache, and green nasal discharge for the 10 days prior to admission. Three days before admission, he developed a fever of 103.5°F. One day prior to admission, he developed periorbital swelling, erythema, and pain in the right eye when looking upwards. He was seen on the day of admission by his pediatrician, who prescribed oral trimethoprimsulfamethoxazole. However, the swelling around his eye progressed, prompting his mother to bring him to the hospital later that evening. His past medical history was significant only for “sinus problems.” He took no other medications, had no significant allergies, and his immunizations were current.