A 16-year-old boy sought care at a rural hospital in Panama for facial swelling that began 3 months earlier. He was seen by a family physician (RU) and a team of medical students who were there as part of a volunteer effort. The patient had difficulty opening his left eye. He denied fever and chills, and said he felt well—other than his inability to see out of his left eye. He denied any changes to his vision when he held the swollen eyelids open. The patient lived on a ranch far outside of town, and he walked down a mountain road alone for 6 hours with one eye swollen shut to present for treatment. The patient was not taking any medications and had not received any health care since his last vaccine several years ago. On physical exam, his vital signs were normal, and the swelling under his left eye was somewhat tender and slightly warm to the touch. There were no lesions on his trunk and the remainder of the exam was normal.
Facial swelling in an adolescent
School of Medicine (Ms. Bambekova, Ms. Morfin, Mr. Buch), Department of Dermatology and Cutaneous Surgery, Department of Family and Community Medicine (Dr. Usatine), University of Texas Health San Antonio
Richard P. Usatine, MD
University of Texas Health at San Antonio
The authors reported no potential conflict of interest relevant to this article.
Clinical findings, as well as the patient’s age and sex, pointed to the diagnosis.