Orbital Cellulitis, Cavernous Sinus Thrombosis, Internal Jugular Vein Thrombus, and Clival Osteomyelitis Secondary to Acute Sinusitis

摘要

A 50-year-old man presented with right eye pain and swelling and progressive vision loss status after a fall. Physical examination showed right eye proptosis with chemosis, ptosis, and lid edema (Figure 1). Computed tomography of head, orbit, and sinuses with contrast revealed right-sided panopacification of the sinuses with bony dehiscence in skull base and right superior ophthalmic vein thrombus (Figures 2 and 3). During hospitalization, the patient developed hemodynamic instability and required mechanical ventilation. Broad-spectrum antibiotics including intravenous vancomycin, cefepime, and metronidazole were initiated. Debridement and drainage of sinuses was performed. Magnetic resonance imaging and magnetic resonance venogram of the brain showed extension of superior ophthalmic vein thrombus to bilateral cavernous sinus thrombosis (Figure 4). The patient was subsequently started on heparin drip and intravenous methylprednisolone 60 mg every 8 hours. Repeated computed tomography of the neck, magnetic resonance imaging of the brain, and magnetic resonance venogram for increased right neck swelling revealed extension to left internal jugular vein thrombosis (Figure 5) and clival osteomyelitis (Figure 6). Blood and sinus cultures grew β hemolytic group C Streptococcus along with the growth of Staphylococcus and Proteus mirabilis from sinuses. We present here an unusual case of rapid progression of acute sinusitis to orbital cellulitis, leading to bilateral cavernous sinus thrombosis, ophthalmic vein thrombosis, internal jugular vein thrombosis, and clival osteomyelitis associated with a rare growth of β hemolytic group C Streptococcus in sinuses and blood.