Herpes zoster in the ophthalmic branch of the trigeminal ganglia obscuring cavernous sinus thrombosis due to Streptococcus constellatus ssp. constellatus

Background: Herpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves. Case: We report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus ssp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis. Conclusions: CST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.

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Septic Cavernous Sinus Thrombosis due to Pneumococcal Meningitis in A 6 Months Infant

10.5327/1516-3180.479 ◽

2021 ◽

Author(s):

Kauan Alves Sousa Madruga ◽

Luiz Fernando Melo Lima ◽

Pedro Victor Oliveira Araújo ◽

Vitória Bittencourt de Carvalho ◽

Bruna Da Cruz Beyruth Borges

Keyword(s):

Cavernous Sinus ◽

Pneumococcal Meningitis ◽

Sinus Thrombosis ◽

Thrombus Formation ◽

Cranial Nerves ◽

Cavernous Sinus Thrombosis ◽

Infection Focus ◽

History Of ◽

Eye Opening ◽

Clinical Thinking

Context: Septic Cavernous Sinus Thrombosis (CST) is a rare and potentially lethal illness that clinicians still occasionally see. We describe the evolution of a 6 months old infant patient who had a history of delayed vaccination and acquired a Pneumococcal Meningitis, leading to septic CTS. Case report: The patient was admitted with the complaint of constant crying and vomiting. The physical exam noticed: bulging of the bregmatic fontanelle, Glasgow Coma Score = 11, and bad general state. The clinical picture had begun one week before the hospitalization, but the fever had started just three days before. The vaccine neglection plus some pathological signs of meningeal infection guided the clinical thinking to meningitis, later confirmed by the lumbar puncture. Some days later, the patient presented paralysis of the third pair of cranial nerves, conducing to the inability to open the eyes, mydriatic non-photo reagent pupils, and bilateral swelling. A magnetic resonance confirmed thrombosis of traverse sinus along with the transition to the sigmoid one. Bilateral ptosis and exotropia were noticed. Antibiotic therapy resulted in progressive eye-opening and recurrence of photo reagent reflexes. The prognosis was great, pointed by the normotension and normal amplitude of the bregmatic fontanelle. Conclusion: The elimination of the meningeal infection focus was extremely important, since the pathophysiology of CST came from phlebitis of the cavernous sinuses, with consequent thrombus formation from the endothelial lesion. In addition, it is worth mentioning the omission of vaccination, which was concessive to the case.

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Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature

The Journal of Laryngology & Otology ◽

10.1258/002221502760237920 ◽

2002 ◽

Vol 116 (9) ◽

pp. 667-676 ◽

Cited By ~ 83

Author(s):

K. Bhatia ◽

N. S. Jones

Keyword(s):

Cavernous Sinus ◽

Sinus Thrombosis ◽

Contemporary Literature ◽

Cranial Nerves ◽

High Dose ◽

Cavernous Sinus Thrombosis ◽

Review Of The Literature ◽

Prospective Trials ◽

Selective Surgery

This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.

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