Invasive Streptococcus viridans sphenoethmoiditis leading to an orbital apex syndrome

Abstract

PurposeOrbital apex syndrome due to spread of infectious sinusitis is a serious disease, often with an insidious presentation with few ophthalmic signs and symptoms. Failure to recognize and treat infectious orbital apex syndrome early portends a grave prognosis, including profound, permanent visual loss and potentially death. Herein we describe a representative case and discuss the relevant aspects of prompt diagnosis and treatment.ObservationsAn unusual case of infectious orbital apex syndrome due to contiguous spread of Streptococcus viridans sphenoethmoiditis in a hospitalized, immunosuppressed patient with acute myelogenous leukemia is presented. Given the few clinic signs and subtle imaging findings, a delay in diagnosis occurred resulting in vision loss to light perception and internal carotid artery occlusion within the cavernous sinus. A brief literature review of orbital apex syndromes is presented.Conclusion and importanceA high clinical suspicion for orbital apex syndrome must be maintained in the appropriate circumstance given the subtle clinical signs and imaging, as well as the potential devastating morbidity of the disease process. Prompt diagnosis and treatment is crucial to patient survival and preservation of vision.

Bilateral orbital apex syndrome secondary to sinusitis

“…Although uncommon, there have been reports of bacterial sinusitis causing OAS, and these are associated with a high risk of permanent visual loss . To our knowledge, our patient is the first case in the literature describing bilateral OAS secondary to sinusitis.…”

“…Orbital apex syndrome (OAS) is an uncommon condition characterised by multiple cranial nerve palsies, including optic nerve dysfunction . We present a rare case of bilateral OAS secondary to bilateral pansinusitis.…”

“…OAS can be caused by a variety of different processes, including infection, inflammation, neoplasms, trauma (or iatrogenic injury) and vascular malformations, such as carotid‐cavernous fistulae . It consists of multiple cranial nerve palsies, including the optic nerve (II) and variable involvement of the oculomotor (III), trochlear (IV), ophthalmic branch of the trigeminal (V 1 ), and abducens (VI) nerves via compression, infiltration or direct injury .…”

More than Meets the Eye: Aspergillus-Related Orbital Apex Syndrome

“…Inhaled fungal spores can commonly colonize the sinuses and lungs, but that does not mean that they will cause overt disease. In these patients with immunocompromising conditions such as diabetes or a history of cancer such as in the patient described, a more aggressive and invasive disease course is likely [2,6]. Acute infections are caused by Aspergillus, Fusarium, and Mucorales while chronic indolent infections are caused by dematiaceous (brown-black molds also known as phaeohyphomycosis) such as Bipolaris, Curvularia, and Alternaria spp.…”