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Cureus Dec 2023Orbital cellulitis is a relatively uncommon complication of sinusitis. Its association with intracranial complications is rare. We present the case of a 36-year-old...
Orbital cellulitis is a relatively uncommon complication of sinusitis. Its association with intracranial complications is rare. We present the case of a 36-year-old patient with no associated risk factors who presented with a four-day history of headache, periorbital inflammation, suppuration, and necrosis. A computed tomography (CT) scan revealed a frontal epidural abscess and signs of chronic pansinusitis. This case highlights the importance of maintaining a high index of suspicion for complications of this condition and the necessity of a multidisciplinary approach in managing this rare complication.
PubMed: 38259410
DOI: 10.7759/cureus.50908 -
Taiwan Journal of Ophthalmology 2023We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and...
PURPOSE
We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.
MATERIALS AND METHODS
This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.
RESULTS
The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage ( = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).
CONCLUSION
Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.
PubMed: 38249495
DOI: 10.4103/tjo.TJO-D-22-00162 -
International Journal of Gynaecology... May 2024
Topics: Pregnancy; Female; Humans; Orbital Cellulitis; Aeromonas hydrophila; Anti-Bacterial Agents; Sepsis
PubMed: 38247226
DOI: 10.1002/ijgo.15376 -
Ophthalmic Plastic and Reconstructive...Orbital abscesses are rarely encountered in children younger than 1 year. The literature is limited to isolated case reports and a few case series. Most such cases are...
Orbital abscesses are rarely encountered in children younger than 1 year. The literature is limited to isolated case reports and a few case series. Most such cases are reported in infants born at term, with the earliest reported gestational birth age at 34 weeks. Children are more prone to orbital cellulitis compared with adults due to their underdeveloped sinuses and immature immune systems, and the origin is most commonly an ethmoid sinus infection. Orbital cellulitis secondary to dacryocystitis is even less common, with only a few isolated cases reported in infants and children. Herein, the authors present a case of a large extraconal and intraconal orbital abscess secondary to nasolacrimal duct obstruction and dacryocystitis in an extremely preterm infant. We discuss the diagnosis and multidisciplinary management of this challenging case.
Topics: Infant; Adult; Child; Humans; Infant, Newborn; Lacrimal Duct Obstruction; Orbital Cellulitis; Dacryocystorhinostomy; Infant, Extremely Premature; Abscess; Nasolacrimal Duct; Dacryocystitis
PubMed: 38241629
DOI: 10.1097/IOP.0000000000002521 -
European Journal of Ophthalmology May 2024To describe a rare case of vision loss due to bilateral edema of the optic nerve in a patient with Hereditary Angioedema, treated with prophylactic C1-esterase inhibitor.
PURPOSE
To describe a rare case of vision loss due to bilateral edema of the optic nerve in a patient with Hereditary Angioedema, treated with prophylactic C1-esterase inhibitor.
METHODS
A 60-year-old Caucasian male affected by Hereditary Angioedema with unknown genetic defect (HAE- UNK) was admitted to our hospital presenting bilateral vision loss (best corrected visual acuity of 20/32 in the right eye and hand motion in the left eye) during an HAE attack. Intravenous administration of C1- esterase inhibitor (C1-INH, 1500 IU, Berinert, CSL Behring) determined the resolution of facial and periorbital swelling, however visual impairment persisted, in contrast with previous attacks experienced by the patient. Fundus examination revealed a vital optic disc without papilledema in both eyes. Magnetic resonance imaging (MRI) of the head and orbits showed bilateral edema of the optic nerve sheath. Treatment with intravenous and oral steroids was ineffective. Subsequently, a prophylactic treatment strategy with subcutaneous C1-esterase inhibitor was started (7000 IU every four days).
RESULTS
Complete regression of edema of the optic nerves was observed by imaging at two months of follow-up after chronic treatment with C1-esterase inhibitor (7000 IU every four days). Complete restoration of visual acuity was achieved (BCVA 20/20 in both eyes) and multimodal imaging of the optic nerves demonstrated the absence of anatomical and functional damage.
CONCLUSION
Patients affected by HAE may show atypical presentation with edema of the optic nerves without involvement of the optic nerve head. They may significantly benefit from prophylactic and chronic treatment with C1-esterase inhibitor.
Topics: Humans; Male; Middle Aged; Magnetic Resonance Imaging; Papilledema; Visual Acuity; Complement C1 Inhibitor Protein; Blindness; Angioedemas, Hereditary; Optic Nerve
PubMed: 38238930
DOI: 10.1177/11206721241228003 -
The American Journal of Case Reports Jan 2024BACKGROUND Superior ophthalmic vein thrombosis (SOVT) is a rare condition, with an incidence of 3 to 4 cases per million per year. SOVT can be classified according to...
BACKGROUND Superior ophthalmic vein thrombosis (SOVT) is a rare condition, with an incidence of 3 to 4 cases per million per year. SOVT can be classified according to the underlying etiology into septic or aseptic SOVT. We present a case of right SOVT in a previously healthy patient with a positive blood culture of methicillin-resistant Staphylococcus aureus (MRSA). CASE REPORT A previously healthy 38-year-old female patient presented with a 2-week history of worsening right-sided headache associated with photophobia, phonophobia, right-sided ear pain, and tinnitus. The best corrected visual acuity was 6/12 in the right eye and 6/6 in the left eye. Ophthalmic examination revealed right eye upper lid edema, proptosis, and diplopia in all gazes, mainly vertical. The fundus examination showed a raised hyperemic right optic disc with blurred margins. Laboratory investigations showed a positive blood culture of MRSA and elevated levels of inflammatory markers erythrocyte sedimentation rate and C-reactive protein. Orbital computed tomography examination showed periorbital and orbital cellulitis with superior ophthalmic vein thrombosis. The patient was treated successfully with antibiotics and anticoagulants. At 1-month follow-up, the patient was compliant with medications and reported full resolution of symptoms, with no visual acuity impairment. CONCLUSIONS SOVT is a challenging ophthalmic condition and can be present concurrent with orbital cellulitis or cavernous sinus thrombosis. Early imaging studies and proper management are important to prevent serious complications. Ophthalmologists need to be alerted of the importance of tailoring antibiotics based on the causative agent, to decrease the risk of therapeutic failure and microbial resistance.
Topics: Female; Humans; Adult; Orbital Cellulitis; Methicillin-Resistant Staphylococcus aureus; Venous Thrombosis; Eye; Anti-Bacterial Agents
PubMed: 38225808
DOI: 10.12659/AJCR.941886 -
Journal of Medical Case Reports Jan 2024Systemic scleroderma (SSc) is an insidious autoimmune connective tissue disorder with multiorgan involvement. Renal involvement is one of the important causes of...
BACKGROUND
Systemic scleroderma (SSc) is an insidious autoimmune connective tissue disorder with multiorgan involvement. Renal involvement is one of the important causes of morbidity and mortality in scleroderma; however, nephrotic syndrome is reported rarely in association with SSc. We present a patient with SSc who developed focal segmental glomerulosclerosis (FSGS) as a complication of scleroderma.
CASE PRESENTATION
A 59 year old Caucasian female patient, with a known history of diffuse systemic sclerosis from 8 years, presented to our clinic with symptoms of anasarca and weight gain. Her physical examination was unremarkable except for periorbital and extremity edema. Her biochemistry assessment revealed decreased serum albumin levels and elevated serum creatinine levels. A renal biopsy was performed, which showed histopathological patterns of FSGS type of nephrotic syndrome. After administration of high doses of steroid and rituximab in the course of her treatment for 6 months, her symptoms and proteinuria were improved without the occurrence of scleroderma renal crises.
CONCLUSION
SSc is a complex multisystemic autoimmune disorder. SRC is the most prominent renal involvement in SSc, but other renal pathologies may also occur. Each patient should be precisely investigated since managing these renal conditions can differ significantly. Nephrotic syndrome is a rare complication of SSc, which could be managed with prompt diagnosis and steroid administration.
Topics: Female; Humans; Middle Aged; Nephrotic Syndrome; Glomerulosclerosis, Focal Segmental; Kidney; Proteinuria; Scleroderma, Systemic; Scleroderma, Localized; Autoimmune Diseases; Steroids
PubMed: 38225664
DOI: 10.1186/s13256-023-04273-6 -
Annals of Medicine and Surgery (2012) Jan 2024Acute sinusitis can cause intraorbital complications. Although subperiosteal abscesses generally do not cause severe vision loss, rare cases of decreased vision due to...
INTRODUCTION AND IMPORTANCE
Acute sinusitis can cause intraorbital complications. Although subperiosteal abscesses generally do not cause severe vision loss, rare cases of decreased vision due to central artery or vein occlusion have been reported since 2003. Central retinal artery occlusion (CRAO) is an eye emergency that can cause sudden loss of vision. This condition is commonly found in elderly individuals with other metabolic diseases. The authors report a case of a type 2 diabetes mellitus (T2DM) patient with CRAO due to suspected rhino-orbital-cerebral mucormycosis (ROCM).
CASE PRESENTATION
A 47-year-old man came with sudden blurred vision since the last week. Examination of the left eye revealed no light perception and vision, orthophoric eyeball position with restricted movement in all directions. Hypaesthesia was observed on the left side of the face. In the anterior segment, oedema of the eyelids, ptosis, conjunctival injection, ciliary injection and chemosis, clear cornea, deep anterior chamber with VH4, brown iris, crypts, no neovascularization of the iris, pupil round, mid-dilated with a diameter of 5 mm, no light reflex, relative afferent papillary defect, and NO2NC2 lens were observed. In the posterior segment, non-uniform fundal reflexes were found, as well as retinal oedema, round papillae, hyperaemic fovea reflex (cherry-red spot), and a cup-to-disc ratio that could not be evaluated. The patient was diagnosed with CRAO, orbital cellulitis, and uncontrolled T2DM. The patient was administered topical and oral antibiotics; however, there was no improvement in the left eye. ROCM was suspected.
CLINICAL DISCUSSION
CRAO is most often caused by embolization or thrombosis associated with atherosclerosis at the lamina cribrosa level. CRAO accompanied by ROCM infection is very rare; to establish the diagnosis, it is necessary to carry out further examinations so that administered therapy can definitely improve the patient's clinical condition. Due to resource limitation, biopsy and MRI were not performed. Surgical debridement was planned when the patient was stable, but the patient missed follow-up appointments.
CONCLUSION
Fungal aetiology should be considered especially in T2DM patient with CRAO that do not improve with antibiotics.
PubMed: 38222772
DOI: 10.1097/MS9.0000000000001504 -
Frontiers in Pediatrics 2023To report and review infantile orbital abscess caused by methicillin-resistant (MRSA).
OBJECTIVE
To report and review infantile orbital abscess caused by methicillin-resistant (MRSA).
METHODS
We report a case of MRSA-induced infantile orbital abscess accompanied by sepsis, pneumonia, and purulent meningitis. We systematically review cases of MRSA-induced infantile orbital abscess published in PubMed, Web of Science and ScienceDirect until April 2023.
RESULTS
We reviewed 14 patients [our patient + 13 patients (10 papers) identified via literature searches]. There were nine boys and five girls; nine neonates and five older infants; and 8 full-term births and 1 preterm birth. The gestational age at birth was unknown for five infants. The right and left orbits were affected in 10 and 4 patients, respectively. The clinical presentation included periorbital soft-tissue edema or redness (11 patients), fever (7 patients), exophthalmos (10 patients), limited eye movement (4 patients), purulent eye secretions (2 patients), and skin abscess and convulsion (1 patient each). The source of infection was sinusitis (8 patients), vertical transmission, gingivitis, dacryocystitis, upper respiratory tract infection (1 patient each), and unknown (2 patients). MRSA was detected in blood (6 patients) or pus culture (8 patients). Vancomycin or linezolid were used for 11 patients; corticosteroids were administered to only 1 patient. Surgical drainage was performed for 13 infants (external drainage, 11 patients; endoscopic drainage, 2 patients). Two patients initially had pulmonary and intracranial infections. Except for one patient with neurological dysfunction at discharge, all other infants had no sequelae or complications.
CONCLUSION
Early aggressive anti-infective treatment and timely drainage are essential for managing MRSA-induced infantile orbital abscess.
PubMed: 38188913
DOI: 10.3389/fped.2023.1272852 -
Cureus Jan 2024Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a...
Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a few days, but there are cases of orbital compartment syndrome that can lead to loss of vision. Here we present the case of a 55-year-old male who came to the emergency department for bilateral periorbital edema associated with non-steroidal anti-inflammatory drug (NSAID) usage, for pain following a fall from a ladder. He was treated with antihistamines and corticosteroids, for presumed allergic reaction, but without response, and subsequently developed acute onset dyspnea. Chest x-ray revealed a left pneumothorax in the context of chest trauma. Chest CT scan after drain placement shows extensive subcutaneous emphysema. In the differential diagnosis of periorbital edema, in addition to allergic, inflammatory, and systemic causes, the traumatic ones should not be excluded.
PubMed: 38187024
DOI: 10.7759/cureus.51691