Orbital Cellulitis Following Stink Bug Toxin Exposure: A Unique Case Report.

Abstract

The authors report a unique case of orbital cellulitis following stink bug (Chinavia hilaris) toxin exposure, highlighting an unrecognized environmental risk factor for periocular infection. A 19-year-old male developed rapidly progressive right periorbital swelling, erythema, and proptosis within 24 hours of direct contact with stink bug secretions after crushing the insect against his cheek. Laboratory findings revealed mildly elevated C-reactive protein (8.2 mg/L) with normal white blood cell counts, and orbital CT confirmed periorbital soft tissue inflammation consistent with orbital cellulitis, without abscess or sinus involvement. The patient was successfully treated with corticosteroids, leading to complete symptom resolution. This case represents the first reported instance of stink bug toxin-associated orbital cellulitis, emphasizing the need for awareness of insect-derived chemical irritants as potential triggers for periocular infection. Early recognition, imaging, and appropriate management are essential in cases of rapidly progressive orbital cellulitis without an identifiable bacterial source. Further toxicological and microbiological research is warranted to explore the inflammatory and infectious effects of insect secretions on human tissues and their potential role in ocular disease.