Truth under a masquerade!

A 32-year-old woman presented with bilateral periorbital oedema of 2 days duration which progressed to proptosis, chemosis with diminution of vision rapidly within a week. She was a known case of adenocarcinoma of the rectum who was treated with surgery and chemotherapy 6 months earlier. Metastasis workup carried out then was negative. On examination, she had bilateral axial proptosis with sluggish pupillary reactions with restricted extra ocular movements. Fundus examination was normal. Systemically, the patient was of poor build and was undernourished. Haemogram showed raised total counts and erythrocyte sedimentation rate. CT orbit and brain showed metastasis to the frontal bones and orbit. On investigating further, the patient had liver and lung metastasis. The patient was started on chemotherapy, but she succumbed to the disease within a week. This case is reported to highlight how bilateral orbital cellulitis can be a presenting sign of systemic metastasis in treated malignancies.