RESUMO
Lemierre's syndrome is a triad consisting of oropharyngeal infection, internal jugular vein thrombophlebitis, and systemic embolisation typically involving lung and brain. Orbital involvement in this life-threatening condition is rare but potentially blinding and may be an indicator of intracranial involvement. We describe a case of odontogenic Lemierre's syndrome complicated by extensive orbital and intracranial septic venous thrombosis, with optic and cranial neuropathy resulting in monocular blindness and ophthalmoplegia. A multidisciplinary approach with abscess drainage, antibiotic and antithrombotic therapy, and close radiological monitoring was critical for preserving contralateral vision and neurological function.
Assuntos
Trombose do Corpo Cavernoso , Síndrome de Lemierre , Oftalmoplegia , Tromboflebite , Trombose Venosa , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/diagnóstico por imagem , Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/diagnóstico por imagem , Tromboflebite/complicações , Tromboflebite/diagnóstico por imagem , Tromboflebite/tratamento farmacológico , Cegueira/etiologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/etiologiaAssuntos
Traumatismos Oculares/diagnóstico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Procedimentos Cirúrgicos Refrativos/efeitos adversos , Retalhos Cirúrgicos/patologia , Traumatismos Oculares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/métodos , Reoperação , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos , Ferimentos e LesõesRESUMO
BACKGROUND: Varicella zoster reactivation is an increasingly recognised event following mRNA COVID-19 vaccination. In addition, various ocular inflammatory and infectious adverse events following COVID-19 vaccination have been described in the literature. This case report describes acute retinal necrosis (ARN) secondary to varicella zoster virus (VZV) reactivation following COVID-19 mRNA vaccination. CASE DESCRIPTION: A 42-year-old immunocompetent man developed left ARN 12 days following first dose of Pfizer BioNTech mRNA COVID-19 vaccination. Aqueous and vitreous tap polymerase chain reaction testing was positive for VZV. Good visual outcome was achieved with combination therapy, including intravitreal foscarnet, oral valaciclovir and prednisolone, topical dexamethasone and atropine, and barrier retinal laser. Second dose of the vaccine is planned under cover of high-dose oral valaciclovir therapy. CONCLUSION: This case illustrates the possible association between COVID-19 vaccination and potentially blinding VZV reactivation. Therefore, prompt ophthalmic assessment is recommended in patients with visual disturbance following COVID-19 vaccination.