S3781 Case of Colon Cancer Presenting as Orbital Cellulitis

Introduction: Colorectal cancer ranks as the third most prevalent cancer, with over a million new diagnoses of it globally each year. Here, we report an unusual case where an orbital metastasis, confirmed through orbital biopsy, was the first presentation of colorectal carcinoma. Case Description/Methods: A 62-year-old woman with prior medical history of chronic sinusitis and recurrent preseptal cellulitis, who presented to the Emergency Department referred from urgent care for further evaluation and management following facial computed tomography (CT) findings of right preseptal soft tissue swelling extending into the right lateral extraconal space suggestive of orbital cellulitis and lytic mass along the right sphenoid/middle cranial fossa. The patient was diagnosed 2 months ago with right preseptal cellulitis and treated with antibiotics. On admission, the patient reported a cough, subjective fever, and runny nose, she is smoking cigarettes and drinks alcohol daily. She has a family history of throat cancer in her brother. She has never had a colonoscopy in the past. On exam: Vital signs were normal, patient was ill-appearing, with right middle ear effusion, nasal congestion, maxillary and frontal sinus tenderness, oropharyngeal erythema, and swelling of the right eyelid. Mild proptosis of the right eye, reduced ocular movement with clear discharge. Blood tests were reassuring except for mild anemia. The patient was started on empiric antibiotics for possible osteomyelitis of the right sphenoid bone, CT chest abdomen, and pelvis was recommended and it showed irregular colonic wall thickening highly suspicious for adenocarcinoma and metastatic lesions in the liver. CEA was 66, the patient underwent a colonoscopy, and a biopsy from the descending colon showed adenocarcinoma. Given the above decision was made to transfer the patient to a higher care facility. The patient was transferred, and underwent craniotomy for tumor resection, pathologic diagnosis was metastatic adenocarcinoma consistent with known colonic primary. Discussion: Colorectal metastasis to the orbit is incredibly rare, Colorectal malignancies frequently spread to the liver, lung, and bone. It is unclear why orbital metastasis is so rare. Anatomical barriers and metastatic pathways may be connected to the uncommon occurrence of colorectal metastasis to the orbit. Management of orbital metastasis currently involves a multidisciplinary approach, including radiation and chemotherapy, as well as surgical debulking at times. However, orbital metastasis is an indicator of poor prognosis.