Orbital Cellulitis with Apparent Thrombosis of the Left Cavernous Sinus and Perioptical Abscess Formation

Excerpt

We report a case of rare complications from acute sinusitis in a 46-year-old woman. She was diagnosed as positive for human immunodeficiency virus (HIV+) 25 years previously and received highly active antiretroviral therapy (HAART) to which she had been non-adherent for nearly 1 year before admission. Following relapsing episodes of sinusitis in the last few months the patient developed stabbing headaches and pain in her left eye that culminated in a complete amaurosis of the left eye with total left ophthalmoplegia within 10 days. A computed tomography (CT) scan at admission (Fig. 1) revealed pansinusitis without evident osteolytic defects in the abutting orbital walls and signs of cavernous sinus thrombosis. An ongoing infection spreading from the paranasal sinus was suspected to be the source of the patient’s progressive signs and symptoms. Antibiotic therapy was initiated and HAART was restarted. In addition, a sphenoidectomy was performed to clear the sphenoid sinus. Microbiologic studies displayed growth of Pseudomonas aeruginosa and Staphylococcus aureus in the removed material.

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