A 16-year-old male with a history of atopic dermatitis presented to his primary care clinic after 7 d of nasal discharge and obstruction, followed by fever and periorbital swelling, which resulted in an inability to open his eyes. He reported headaches and facial and ocular pain at the hospital 2 d later. He appeared slightly lethargic, had a body temperature of 39.1 °C, a white blood cell count of 15,100/μL, and a C-reactive protein of 13.6 mg/dL. Physical examination revealed erythema, swelling, warmth, and tenderness from the forehead to the right upper eyelid and cheek (Fig 1A).
