Orbital cellulitis and cavernous sinus thrombosis with contralateral sinus disease in a COVID-19 positive adolescent patient

Abstract Background Isolated sphenoid sinus disease (ISSD) is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurologic, and vascular structures nearby. Case report We present a case of a 60-year-old female with a history of severe left-sided headache, facial pain, diplopia, and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. MRI scans revealed opacification in left sphenoid sinus consistent with left sphenoid sinusitis. There were no signs of cavernous sinus thrombosis. She was then referred to ENT and underwent endoscopic transnasal sphenoidotomy procedure. Culture results showed Haemophilus Influenza and fungal pseudohyphae. Her palsy and headaches recovered completely 3 months later with a course of antibiotics and antifungals. Literature review for lateral rectus palsy secondary to sphenoid sinusitis without cavernous sinus thrombosis showed it is not a common condition and this case report should serve as a reminder to consider paranasal sinus disease when assessing these patients. Conclusions The onset of ISSD is often insidious and diagnosis of this condition remains a challenge. MRI and CT imaging remain the gold standard for recognising and managing this condition.

Download Full-text

Orbital Complications of Rhinosinusitis in the Adult Population: Analysis of Cases Presenting to a Tertiary Medical Center Over a 13-Year Period

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419832624 ◽

2019 ◽

Vol 128 (6) ◽

pp. 563-568 ◽

Cited By ~ 3

Author(s):

Aiman El Mograbi ◽

Amit Ritter ◽

Esmat Najjar ◽

Ethan Soudry

Keyword(s):

Chronic Rhinosinusitis ◽

Cavernous Sinus ◽

Sinus Thrombosis ◽

Orbital Cellulitis ◽

Sinus Surgery ◽

Cavernous Sinus Thrombosis ◽

Surgical Drainage ◽

Acute Rhinosinusitis ◽

Orbital Wall ◽

Orbital Complications

Background: Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. Objective: To review our experience with the management of orbital complications of rhinosinusitis in the adult patient population and identify key factors in the characteristics and management of these patients. Design: Retrospective case series during the years 2004 to 2016 in a tertiary referral center including all patients with rhinosinusitis and orbital complications. Main Outcomes and Measures: Severity of complications, risk factors, clinical, imaging and microbiological data, treatment outcomes. Results: Seventy patients were identified. Median age at diagnosis was 38 years. In 57%, complications were associated with acute rhinosinusitis and in 43% with chronic rhinosinusitis, most of whom had a history of previous sinus surgery. Thirty-five percent of patients received antibiotics prior to admission. The majority of the previously operated patients (61%) had some form of orbital wall dehiscence noted on imaging. Preseptal cellulitis was the most common complication (61.5%) encountered, followed by orbital cellulitis (23%), sub-periosteal abscess (11.5%), orbital abscess (3%), and cavernous sinus thrombosis (1.5%). Gram-positive bacteria were more commonly isolated from acute rhinosinusitis patients and gram-negative bacteria from chronic rhinosinusitis (CRS) patients. Complete recovery was noted in all patients, of whom 85% were managed conservatively. All, but 1 patient, with an abscess or cavernous sinus thrombosis required surgical drainage. Older age was the only risk factor identified for severe complications. Conclusions: In contrast to the pediatric population, CRS is very common in adults with orbital complications of rhinosinusitis, with previous sinus surgery and orbital wall dehiscence being noticeably common. Older patients are at risk for more severe complications. Conservative treatment suffices in patients with preseptal and orbital cellulitis. In more advanced stages, surgical drainage is advocated with excellent results. Larger cohort studies are needed to further investigate this patient group.

Download Full-text

Cavernous Sinus Thrombosis as Complications of Cellulitis Orbital: Case Report

International Journal of Research and Review ◽

10.52403/ijrr.20211032 ◽

2021 ◽

Vol 8 (10) ◽

pp. 248-251

Author(s):

Astari Arum Cendani Goller ◽

Kumara Tini

Keyword(s):

Cavernous Sinus ◽

Sinus Thrombosis ◽

Orbital Cellulitis ◽

High Morbidity ◽

Cavernous Sinus Thrombosis ◽

Blurred Vision ◽

The Face ◽

History Of ◽

Laboratory Investigations ◽

Visual Complaints

Background: Cavernous sinus thrombosis is a complication of infection around the face or paranasal sinuses with high morbidity and mortality rates. Cavernous sinus thrombosis is generally caused by septic infection, such as orbital cellulitis. Case Illustrations: A 35-year-old male who came to the neurology polyclinic complained of swelling in the left eyelid, red, watery eyes, blurred vision, difficulty opening the left eye, and the movement of the left eyeball felt normal. The patient had a history of left orbital cellulitis. Laboratory investigations showed an increase in inflammatory markers. The CT scan with contrast showed a hyperdense lesion in the left orbit, suggesting orbital cellulitis. The patient was diagnosed with a cavernous sinus thrombosis due to orbital cellulitis. He was treated with an antibiotic, anticoagulant, and corticosteroid. Three months after treatment, the visual complaints improved, the headache decreased drastically, and we did not find any extraocular muscles weakness. Conclusions: The administration of antibiotics and anticoagulant therapy in patients with cavernous sinus thrombosis has been proven clinically. The use of corticosteroids has not been proven but is strongly suspected to reduce edema caused by compression of the cavernous sinus. Keywords: Cavernous sinus thrombosis, orbital cellulitis. infections.

Download Full-text