RESUMEN
Orbital cellulitis is a serious, life-threatening infection, typically in paediatric patients, and its bilateral presentation in adults is atypic. We present an unusual bilateral manifestation of orbital cellulitis and abscess, caused by Enterococci in an adult patient. E. faecalis is an extremely rare cause of orbital inflammation and we found three published case reports only, all of which are unilateral and seen in children. A 51-year-old male presented with 1-week history of pyrexia, painful proptosis, periorbital swelling, and low vision of both eyes. He was diagnosed with bilateral orbital cellulitis and was treated with empiric antibiotic medication for 8 days, but symptoms persisted. MRI showed bilateral intra- and extraconal fluid-intensity collections. Microbiology was taken from the orbit and revealed Enterococcus faecalis invasion. Pus collections were drained for 1 week. Systemic and intraorbital antibiotics were administered. The patient recovered and vision returned to normal. This is a rare case of bilateral orbital cellulitis and abscesses with invasive E. faecalis infection. E. faecalis infection of the orbit is unusual and should be considered, especially if patient does not respond to empiric antibiotic therapies.
RESUMEN
Angioedema is an asymmetric non-pitting oedema on face, lips, tongue and mucous membranes; any delay in diagnosis and treatment can be fatal. Treatment with lisinopril as an angiotensin converting enzyme (ACE) inhibitor, can be a reason of angioedema. Here we report a case who developed oral-facial edema four years after using lisinopril/hydrochlorothiazide. Laryngeal oedema is a main cause of death in angioedema. The treatment of choice in angioedema including fresh frozen plasma, C1 inhibitor concentrations and BRK-2 antagonists (bradykinin B2 receptor antagonists) were used. In this case; a 77 years old female patient suffering from hypertension was considered. This patient was suffering two days from swelling on her face and neck. Non- allergic angioedema was distinguished in five major forms; acquired (AAO), hereditary (HAE), renin-angiotensin-aldosterone system (RAAS) blocker-dependent, pseudoallergic angioedema (PAS) and an idiopathic angioedema (IAO). She was admitted to our clinic with the diagnosis of hereditary angioedema. Patient had skin edema and life threatening laryngeal edema. In emergency department treatment was started using intravenous methylprednisolone, diphenydramine as well as inhaled and subcutaneous epinephrine simultaneously. Despite the initial treatment, the patient died due to the insufficient respiration and cardiac arrest. The patient has no history of kidney disease.
