Shaikh M R, Baqir M, Zakir N.
Orbital cellulitis masquerading as Cavernous Sinus Thrombosis - a Case Report.
J Pak Med Assoc Jan ;54(5):280-2.

A 40 year old man, presented to ER with left facial swelling, proptosis of left eye, sudden loss of vision, headache, nausea and low grade fever. Symptoms started 10 days prior with mild headache and otalgia. On arrival he was alert, oriented, vitally stable with mild tachycardia. On examination he was a well built man with obvious swelling of left face, severe proptosis and chemosis of left eye, left mastoid swelling and left complete ophthalmoplegia involving 3, 4, 6 cranial nerves. With left LMN type of 7th nerve palsy, sensory deficit was noted in distribution of ophthalmic division of trigeminal nerve. Patient had conductive hearing loss on left ear with loss of direct and consensual light reflexes in the same eye with dilated and fixed pupil. Fundoscopy showed pale retina and mild papilledema. WBC count was 19.8 with 88.2 % polys at the time of admission. CT scan showed severe orbital cellulitis with inflammatory changes in ethmoid, spheniod and maxillary sinuses and no evidence of orbital abscess. MRI Post Gadolinium contrast imaging showed same findings with no element of cavernous sinus thrombosis or extension of infection to Brain. Ophthalmology examination showed severe orbital infection and evidence of endophthalmitis. Patient underwent functional endoscopic sinus surgery on the same day of admission. Despite administration of broad spectrum antibiotics, pain and swelling of the face increased and WBC counts rose to 25.6 within 48 hours. Antibiotics were changed to Amikacin, Meropenem and Amphoterecin B. Vancomycin was started later when tissue culture showed moderate growth of Staph epidermidis and fungal cultures were negative. On 9th day of admission patient was stable with falling WBC counts, and no fever. Pain and swelling subsided. He was discharged on oral Clindamycin, Itroconazole and Ciprofloxacin for 14 days . At the time of discharge patient had no vision in left eye.

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