A rare case of infantile dacryoadenitis: a case report.

A 10-month-old boy, otherwise healthy, presented with significant left upper eyelid edema, erythema, and near-complete ptosis. He was afebrile and nontoxic. Examination revealed an inflamed lacrimal gland, with no other orbital signs. There was mild leukocytosis and elevated ESR and CRP. Intravenous ampicillin/sulbactam was initiated. Forty-eight hours later, the contralateral eyelid developed similar symptoms. Blood cultures, respiratory viral panel, COVID-19 antigen, and EBV serologies were negative. Orbital imaging revealed moderate bilateral lacrimal gland enlargement without abscess or other abnormalities. The patient's symptoms steadily improved, and therapy was transitioned to oral antibiotics, ibuprofen, and topical steroids. CRP and leukocytosis peaked at 11 and 18 days after presentation, respectively, and subsequently normalized. Pediatric rheumatology consultation did not identify any underlying systemic cause, and tissue biopsy was not pursued. The child recovered completely and remains asymptomatic. This case highlights a rare presentation of bilateral dacryoadenitis in infancy. We discuss the relevant inflammatory markers that can be used to differentiate between various infectious and inflammatory etiologies.