Orbital Cellulitis, Cavernous Sinus Thrombosis, Pyomyositis of Extraocular Muscle, Bacteremia
A 17-year-old female with no significant PMH presented to the BPEI Emergency Room with a red, swollen left eye for two days in the setting of recent lower lid lesion that the patient believed was a chalazion. Examination revealed 20/100 vision, proptosis, elevated IOP, and fever. The patient was transferred emergently to our nearby children’s hospital for initiation evaluation for orbital cellulitis. The patient was immediately started on intravenous antibiotics, and CT and MRI imaging revealed pre- and post-septal inflammation, cavernous sinus thrombosis, pyomyositis of the lateral rectus muscle, and likely ophthalmic artery thrombosis. With the assistance of the general medicine, otolaryngology, neurology, and hematology/oncology teams, the patient was managed medically with intravenous antibiotics, anticoagulation, and close follow-up with frequent exams. Her visual symptoms improved and she did not require surgery. She was able to be discharged on intravenous antibiotics and anticoagulation. Following discharge, at her outpatient follow-up visit on day eighteen since initial presentation, she had 20/20 vision bilaterally, full extraocular movements, and felt that she was at her baseline.
Presentation Date: 10/01/2020
Issue Date: 02/12/2021
Please log in or click on ENROLL ME to access this course.
