RESUMEN
An 86-year-old patient was hospitalized for fever and left acute orbital syndrome (red eye with moderate visual impairment, chemosis, ophthalmoplegia without proptosis, or any fundus involvement). CT scan showed superior ophthalmic vein and cavernous sinus enlargement complicating ipsilateral sphenoidal sinusitis. Magnetic resonance imaging (MRI) demonstrated the left cavernous sinus thrombosis extended to the ipsilateral jugular vein and transversal sinus (Lemierre syndrome). Intravenous broad-spectrum antibiotics and curative anticoagulation were prescribed. Blood cultures allowed the identification of Streptococcus intermedius and Staphylococcus warneri species. Evolution was favorable and the patient was discharged 3 weeks after. Antibiotics and anticoagulation were carried out for a total duration of 4 and 12 weeks, respectively. Lemierre syndrome is a potentially life-threatening emergency rarely encountered; thus, ophthalmologists should be cognizant of clinical and radiological features. Broad-spectrum antibiotics are the mainstay of treatment. Curative anticoagulation may be added if no blood coagulation disorder nor bleeding on neuroimaging has been identified.
Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico por imagen , Venas Yugulares/patología , Síndrome de Lemierre/diagnóstico por imagen , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Trombosis del Seno Cavernoso/tratamiento farmacológico , Trombosis del Seno Cavernoso/microbiología , Humanos , Síndrome de Lemierre/tratamiento farmacológico , Síndrome de Lemierre/microbiología , Imagen por Resonancia Magnética , Masculino , Enfermedades de los Senos Paranasales/tratamiento farmacológico , Enfermedades de los Senos Paranasales/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus/aislamiento & purificación , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Streptococcus intermedius/aislamiento & purificación , Tomografía Computarizada por Rayos XRESUMEN
The present review was designed to represent modern views of the problem of etiopathogenesis, clinical features, diagnostics, and treatment of septic thrombus of the cavernous sinus with special reference to the currently available methods for the detection and management of this condition.
Asunto(s)
Antibacterianos/farmacología , Anticoagulantes/farmacología , Trombosis del Seno Cavernoso , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/microbiología , Trombosis del Seno Cavernoso/terapia , Quimioterapia Combinada/métodos , Intervención Médica Temprana , Humanos , Angiografía por Resonancia Magnética/métodos , Pronóstico , Tomografía Computarizada por Rayos X/métodosRESUMEN
Infectious intracranial aneurysm and cavernous sinus thrombosis are rare complications of orbital cellulitis. We report the case of a 46-year-old male presenting with sinusitis and orbital cellulitis complicated by the development of an orbital mass. Following orbitotomy with debulking, the patient underwent bony orbital decompression for increasing proptosis postoperatively. While his exam stabilized, the patient developed complete ptosis and extraocular motor palsy in the contralateral eye after undergoing bilateral sinus debridement. Imaging was notable for the presence of a pseudoaneurysm of the internal carotid artery, which was treated with a stent. This report demonstrates rare complications of orbital cellulitis. These patients should be monitored carefully with noninvasive imaging studies, such as cerebral angiography, for early detection of vascular abnormalities that can progress rapidly.
Asunto(s)
Trombosis del Seno Cavernoso/etiología , Trombosis del Seno Cavernoso/microbiología , Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/microbiología , Celulitis Orbitaria/complicaciones , Celulitis Orbitaria/cirugía , Trombosis del Seno Cavernoso/diagnóstico por imagen , Desbridamiento , Descompresión Quirúrgica , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Celulitis Orbitaria/diagnóstico por imagen , Radiografía , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/cirugíaRESUMEN
Cavernous sinus thrombosis (CST) is a rare disease with the potential for significant morbidity and even death. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. The cause may be aseptic or infectious. When the cause is infectious in nature, it is most commonly from a bacterial origin. However, we present the case of a 57-year-old man with a fungally related CST that ultimately led to his death.
Asunto(s)
Aspergilosis/diagnóstico , Trombosis del Seno Cavernoso/microbiología , Ceguera/microbiología , Diagnóstico Diferencial , Parálisis Facial/microbiología , Resultado Fatal , Humanos , Masculino , Sinusitis Maxilar/microbiología , Persona de Mediana Edad , Celulitis Orbitaria/microbiologíaAsunto(s)
Dermatomicosis/diagnóstico , Dermatosis Facial/diagnóstico , Mucormicosis/diagnóstico , Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Trombosis del Seno Cavernoso/microbiología , Mejilla , Enfermedades de los Nervios Craneales/microbiología , Dermatomicosis/tratamiento farmacológico , Dermatosis Facial/tratamiento farmacológico , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológicoRESUMEN
A 45-year-old patient presented with bilateral orbital abscesses. He was found to have Lemierre syndrome, a condition involving septic thrombophlebitis of the internal jugular vein. The patient developed severe proptosis, sepsis, and cavernous sinus thrombosis. Despite aggressive antibiotic and anticoagulation therapy, visual loss was rapid, and the patient ultimately died. Lemierre syndrome, previously thought to be rare, is now becoming more commonly reported. Its prompt diagnosis and treatment are essential for patient survival.
Asunto(s)
Absceso/microbiología , Bacteriemia/microbiología , Síndrome de Lemierre/microbiología , Enfermedades Orbitales/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus milleri (Grupo)/aislamiento & purificación , Absceso/diagnóstico , Absceso/terapia , Bacteriemia/diagnóstico , Bacteriemia/terapia , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/microbiología , Resultado Fatal , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/terapia , Masculino , Persona de Mediana Edad , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Cases of acute sphenoid sinusitis complicated by septic cavernous sinus (CS) thrombosis and internal carotid artery (ICA) stenosis are rarely reported. Different causative pathogens have been reported for this condition. We present two extremely rare and special cases with diverse clinical presentations and outcomes. Case 1 involved a female patient with less extensive sinusitis, but critical ICA occlusion. Case 2 involved a male patient with extensive pansinusitis, meningitis, cerebritis, and vasculitis due to fungal infection, but less stenosis of the ICA lumen. Both patients underwent surgical debridement and received broad-spectrum antibiotics. Additional anti-fungal medication was also administered in Case 2. However, outcomes differed considerably between cases. DISCUSSION: Case 1 recovered with minimal neurological deficits and had Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores of 5 and 2, respectively; however, the Case 2 had GOS and mRS scores of 3 and 4, respectively. Although rare, septic CS thrombosis with ICA stenosis can lead to unexpected and severe neurological sequelae. Fungal infection can result in catastrophic complications and poorer prognosis. CONCLUSION: In addition to early detection, aggressive surgical debridement and adequate antimicrobial treatment are crucial to satisfactory outcomes in patients with septic CS thrombosis complicated with ICA stenosis.
Asunto(s)
Arteria Carótida Interna/patología , Estenosis Carotídea/fisiopatología , Trombosis del Seno Cavernoso/complicaciones , Enfermedades del Sistema Nervioso/patología , Sepsis/complicaciones , Adulto , Antibacterianos/uso terapéutico , Trombosis del Seno Cavernoso/tratamiento farmacológico , Trombosis del Seno Cavernoso/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Pronóstico , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Adulto JovenRESUMEN
Neglect of odontogenic infections can have serious consequences. If they spread through fascial planes and intracranially they can cause an abscess, orbital cellulitis, and eventually cavernous sinus thrombosis. The authors report a case of rapid progressive bilateral orbital cellulitis and cavernous sinus thrombosis that originated from dental caries. Septic cavernous sinus thrombosis is a medical emergency. Early recognition and prompt treatments direct to the underlying sources of infection are crucial. Broad-spectrum intravenous antibiotics are the mainstay of treatment to reduce morbidity and mortality from this lethal condition. Management should be based on early diagnosis and prompt management with intravenous broad-spectrum antibiotics and surgical intervention.
Asunto(s)
Trombosis del Seno Cavernoso/microbiología , Infección Focal Dental/complicaciones , Enfermedades Orbitales/diagnóstico , Enfermedades Faríngeas/complicaciones , Infecciones por Pseudomonas/diagnóstico , Sepsis/complicaciones , Absceso/complicaciones , Absceso/terapia , Antibacterianos/uso terapéutico , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/tratamiento farmacológico , Trombosis del Seno Cavernoso/cirugía , Drenaje , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/etiología , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/cirugía , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/cirugía , Pseudomonas aeruginosa/aislamiento & purificación , Sepsis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Agudeza VisualRESUMEN
OBJECTIVES: We describe a case of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infection leading to bilateral cavernous sinus thrombosis (CST) and subsequent left eye blindness in a previously healthy, immunocompetent woman. A secondary objective is to document all published cases of MRSA induced CST. DATA SOURCE AND STUDY SELECTION: To identify all relevant publications on MRSA-induced CST in adults. RESULTS: Seven publications were included in this review describing patients age 19 or older. Together, with the case included in this publication, a total of 8 cases of MRSA induced CST have been documented since 2003. Of interest, to our knowledge this is the first reported case of CA-MRSA CST temporally associated with nasal H1N1 vaccination. CONCLUSION: In selecting empiric antibiotic coverage for septic CST, the practitioner should use antibiotics that are active against CA-MRSA to help prevent morbidity and mortality.
Asunto(s)
Trombosis del Seno Cavernoso/microbiología , Vacunas contra la Influenza/efectos adversos , Staphylococcus aureus Resistente a Meticilina , Infecciones Cutáneas Estafilocócicas/complicaciones , Administración Intranasal , Adulto , Ceguera/etiología , Trombosis del Seno Cavernoso/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Humanos , Vacunas contra la Influenza/administración & dosificación , Mississippi , Infecciones Cutáneas Estafilocócicas/microbiologíaRESUMEN
BACKGROUND AND PURPOSE: Septic cavernous sinus thrombosis (CST) is a rare, life-threatening disease with infectious thrombosis causing associated complications resulting in high morbidity and mortality. We report a series of CST patients with assessment of arterial and intracranial complications. METHODS: We used the radiology database from a large, academic tertiary care center to collect all patients treated with CST between 2002 and 2019. Patient demographics, source of infection, treatment course and outcomes were evaluated. A review of the recent literature was also performed for similar reported complications from CST. RESULTS: 14 patients with CST treated during this time period were assessed. Of the 14 patients, 1 patient died. 7 patients had unilateral narrowing of ICA while 3 patients had bilateral narrowing. The ICA narrowing was reversible in 10/12 patients and improvement but persistent narrowing in one patient. One patient had an infectious pseudo aneurysm that was treated by coiling. Extension of thrombosis to the transverse- sigmoid sinuses and internal jugular vein were seen in 3 patients. Three patients had subdural empyema which was treated surgically. CONCLUSION: The prognosis of CST has improved with advancement in treatment, but complications are not infrequent.
Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico por imagen , Sepsis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trombosis del Seno Cavernoso/complicaciones , Trombosis del Seno Cavernoso/microbiología , Niño , Preescolar , Bases de Datos Factuales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sepsis/complicaciones , Sepsis/microbiología , Infecciones Estafilocócicas/microbiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
We report a case of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) bacteraemia with cavernous sinus thrombosis, meningitis and brain abscess in a previously healthy American, who was employed in Belgium. We consecutively reviewed all published cases of CA-MRSA with central nervous system (CNS) involvement. A total of 12 similar cases were found, of which 11 were published in the last 4 years. Predominantly, young previously healthy subjects were affected (median age 28 years). The cases involved brain abscesses (5/12), disseminated disease (4/12), cavernous sinus thrombosis (2/12) and other (1/12). Infection origins were superficial skin infections (5/12), mostly of the face, sinusitis (1/12), otitis media (1/12), other or unknown (5/12). Although, in our review of the literature patients treated with linezolid had a better outcome compared to patients treated with vancomycin, the latter is still the mainstay of therapy for CNS infections associated with MRSA.
Asunto(s)
Trombosis del Seno Cavernoso/microbiología , Infecciones Bacterianas del Sistema Nervioso Central/microbiología , Infecciones Comunitarias Adquiridas/microbiología , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/microbiología , Adulto , Antibacterianos/uso terapéutico , Bacteriemia , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/microbiología , Trombosis del Seno Cavernoso/tratamiento farmacológico , Trombosis del Seno Cavernoso/cirugía , Infecciones Bacterianas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Bacterianas del Sistema Nervioso Central/cirugía , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/cirugía , Resultado Fatal , Humanos , Masculino , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/cirugíaRESUMEN
A 29-year-old man developed vision loss in the right eye due to ophthalmic artery, cavernous sinus, and superior ophthalmic vein occlusion in mucormycosis. Diffusion MRI obtained within 2 days of symptom onset showed that the apparent diffusion coefficient values of the optic nerve and retina were remarkably decreased on the affected compared with the unaffected side. A follow-up MRI study 21 days after symptom onset revealed the anticipated disappearance of these signal changes, confirming that they were a true reflection of ischemia in the optic nerve and retina. This report adds to an accumulating body of literature on restricted diffusion in these tissues in conditions producing severe ischemia.
Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Mucormicosis/diagnóstico , Nervio Óptico/patología , Enfermedades de los Senos Paranasales/diagnóstico , Retina/patología , Adulto , Ceguera/etiología , Trombosis del Seno Cavernoso/microbiología , Imagen de Difusión por Resonancia Magnética , Infecciones Fúngicas del Ojo/microbiología , Resultado Fatal , Humanos , Masculino , Mucormicosis/microbiología , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/microbiología , Enfermedades de los Senos Paranasales/microbiologíaRESUMEN
Cavernous sinus thrombosis (CST) is a rare and serious complication secondary to invasive fungal sinusitis, but rarer still in cases of allergic fungal sinusitis. Current recommendations for cavernous sinus thrombosis are controversial, especially regarding anticoagulation, secondary to the rarity of the diagnosis. Early surgical debridement and intravenous antibiotics are crucial to prevent mortality and decrease morbidity. Because thrombosis is thought to be caused by a bacterial superinfection, which follows a response to Aspergillus, antifungals may not be necessary. Despite the controversy, most physicians opt to treat with anticoagulation.
Asunto(s)
Aspergilosis/complicaciones , Aspergillus fumigatus , Trombosis del Seno Cavernoso/microbiología , Hipersensibilidad Respiratoria/complicaciones , Sinusitis/complicaciones , Sinusitis/microbiología , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/terapia , Humanos , Masculino , Persona de Mediana Edad , Sinusitis/terapiaRESUMEN
We report on a rare case of a patient with rhinocerebral mucormycosis that presented as intracerebral hemorrhage (ICH). A 54-year-old man who was immunosuppressed had ophthalmoplegia. Four days later, ICH developed in his left frontal lobe. The ICH was surgically removed totally. Pathology specimen surgically obtained from brain surface adjacent to hematoma cavity showed blood vessels filled with Mucor mycelium. Combined with surgical findings, venous occlusion by Mucor mycelium might be the cause of ICH in the patient.
Asunto(s)
Arterias Cerebrales/microbiología , Arterias Cerebrales/patología , Hemorragia Cerebral/microbiología , Hemorragia Cerebral/patología , Mucormicosis/complicaciones , Mucormicosis/patología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Trasplante de Médula Ósea , Trombosis del Seno Cavernoso/complicaciones , Trombosis del Seno Cavernoso/microbiología , Arterias Cerebrales/cirugía , Hemorragia Cerebral/cirugía , Craneotomía , Resultado Fatal , Lóbulo Frontal/irrigación sanguínea , Lóbulo Frontal/patología , Humanos , Huésped Inmunocomprometido/fisiología , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Oftalmoplejía/etiología , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , Trombosis de la Vena/complicaciones , Trombosis de la Vena/microbiologíaRESUMEN
In this magnetic resonance imaging-based study, we investigated the clinical features, neuroimaging features and therapeutic outcomes of 14 adults (eight men and six women; mean age 60.4â¯years; range 37-77â¯years) with septic cavernous sinus thrombosis (CST). Of the underlying conditions, 10 had diabetes mellitus and 13 had concomitant sphenoid sinusitis. Headache (nâ¯=â¯13) and ophthalmoplegia (nâ¯=â¯13) were the most common clinical presentations, followed by fever (nâ¯=â¯9) and other neuro-vascular signs and symptoms. The duration from the onset of symptoms to diagnosis ranged from 1 to 61â¯days, and more than 64% (9/14) of the septic CST patients were diagnosed >7â¯days after symptom onset. Expansion of the cavernous sinus was the most common neuroimaging feature, followed by convexity of the lateral wall of the cavernous sinus (5) and filling defect of the cavernous sinus (4). Staphylococcal species (spp.) was the most commonly implicated pathogen, followed by Aspergillus spp. Despite treatment, 7% (1/14) of the patients died in the hospital and 67% (8/12) of the survivors had neurological deficits. The duration of onset-to-diagnosis and the presence of hemiparesis were significant prognostic factors. These results provide a preliminary view of this uncommon infectious syndrome. Further large-scale studies are needed to better delineate septic CST in adults.
Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/microbiología , Adulto , Anciano , Antiinfecciosos/uso terapéutico , Trombosis del Seno Cavernoso/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Borrelia crocidurae is endemic in West Africa, where it represents the leading cause of tick-borne relapsing fever (TBRF). TBRF typically presents with high fever and systemic symptoms, followed by recurrent episodes. Neurological complications may occur during febrile relapses. B. crocidurae is considered the most neurotropic agent of TBRF and is associated to severe neurological manifestations i.e. meningitis and encephalitis. To date, European cases of B. crocidurae infection have been reported in travelers returning from endemic areas. We report the first autochthonous case in Europe of B. crocidurae infection, presenting as meningitis with cranial polyneuritis and cavernous sinus thrombosis that were not preceded by classic febrile recurrences.
Asunto(s)
Borrelia/aislamiento & purificación , Trombosis del Seno Cavernoso/diagnóstico por imagen , Encefalitis/diagnóstico por imagen , Meningitis/diagnóstico por imagen , Neuritis/diagnóstico por imagen , Fiebre Recurrente/diagnóstico por imagen , Adulto , Animales , Borrelia/genética , Trombosis del Seno Cavernoso/microbiología , Encefalitis/microbiología , Europa (Continente) , Femenino , Humanos , Meningitis/microbiología , Persona de Mediana Edad , Neuritis/microbiología , Fiebre Recurrente/microbiologíaRESUMEN
We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.
Asunto(s)
Trombosis del Seno Cavernoso/microbiología , Trombosis del Seno Cavernoso/cirugía , Seno Cavernoso/microbiología , Ventriculostomía/métodos , Administración Intravenosa , Cuidados Posteriores , Anciano , Angiografía/métodos , Antibacterianos/uso terapéutico , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/patología , Trombosis del Seno Cavernoso/diagnóstico por imagen , Trombosis del Seno Cavernoso/tratamiento farmacológico , Ceftriaxona/administración & dosificación , Ceftriaxona/uso terapéutico , Femenino , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Humanos , Inyecciones Intraventriculares/métodos , Imagen por Resonancia Magnética/métodos , Meningitis/diagnóstico por imagen , Meningitis/tratamiento farmacológico , Meningitis/microbiología , Metronidazol/administración & dosificación , Metronidazol/uso terapéutico , Sinusitis/complicaciones , Sinusitis/cirugía , Resultado del TratamientoRESUMEN
Septic cavernous sinus thrombosis is an uncommon clinical syndrome with a high morbidity and mortality. The commonest bacterial pathogen is Staphylococcus aureus. We describe the study of a patient with cavernous sinus thrombosis and meningitis caused by community-acquired methicillin-resistant S. aureus (CA-MRSA) infection. The isolate was genotyped as the ST93 (Queensland) clone of CA-MRSA and carried the Panton-Valentine leucocidin genes. Cure was obtained following prolonged antimicrobial therapy with vancomycin, rifampicin, cotrimoxazole and linezolid. Given the high morbidity and mortality of cavernous sinus thrombosis and the worldwide recent emergence of CA-MRSA, clinicians treating patients with this infection should consider early empirical coverage for CA-MRSA with an antimicrobial agent, such as vancomycin or linezolid, particularly in the presence of suspected facial staphylococcal skin infections. If vancomycin is used, we emphasize that high doses may be required to achieve even low levels in the cerebrospinal fluid.
Asunto(s)
Trombosis del Seno Cavernoso/microbiología , Meningitis Bacterianas/microbiología , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus/aislamiento & purificación , Adulto , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/terapia , Infecciones Comunitarias Adquiridas , Humanos , Masculino , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/terapia , Resistencia a la Meticilina , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/genéticaRESUMEN
A 51-year-old woman with left proptosis, diplopia, headache, and nausea was found to have bilateral intraorbital abscesses, left superior ophthalmic vein thrombosis, bilateral cavernous sinus thromboses, and a left temporal lobe intracerebral abscess. Because the paranasal sinuses were unaffected, a dental origin was suspected and confirmed. The causative organism was Streptococcus milleri. Aggressive surgical intervention included bilateral orbital abscess drainage and dental extraction, and medical therapy included intravenous metronidazole, ceftriaxone, heparin, and methylprednisolone. A left sixth cranial nerve paresis was the only long-term sequela.
Asunto(s)
Absceso/microbiología , Trombosis del Seno Cavernoso/microbiología , Infecciones Bacterianas del Ojo/microbiología , Enfermedades Orbitales/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus milleri (Grupo)/aislamiento & purificación , Absceso/diagnóstico , Absceso/terapia , Antibacterianos/uso terapéutico , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/terapia , Terapia Combinada , Drenaje/métodos , Quimioterapia Combinada , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/terapia , Femenino , Lateralidad Funcional , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Extracción Dental , Resultado del TratamientoRESUMEN
Septic cavernous sinus thrombosis (SCST) is an uncommon consequence of head and face infection, but a rare complication after craniofacial fracture. In this case, SCST developed in a 13-year-old girl following a minor fall during volleyball, with impact and resulting abrasive contusion of the left forehead. She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. Drowsiness, high-grade fever, severe headache, left ocular pain with marked periorbital swelling, and paralysis of extraocular eye movements developed. Computed tomography scan identified left sphenoid and ethmoid sinusitis, a posterior clinoid fracture, and septic cavernous sinus thrombosis. She died after 10 days of in-hospital antibiotic therapy. Death was due to Staphylococcus aureus sepsis with septic pulmonary thromboemboli due to suppurative meningitis and cerebral infarction, due to SCST following apparently minor blunt head injury from an accidental fall.