Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient

Abstract

IntroductionComplications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.Case presentationWe described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.ConclusionThe case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.

Bacterial profile of ocular infections: a systematic review

“…Upper respiratory tract infections of Streptococcal and Staphylococcal origin are sometimes associated with orbital cellulitis and other complications. For instance, orbital cellulitis, endophthalmitis and acute pan-sinusitis was reported as a complication of Streptococcal pharyngitis due to S. pyogenes [ 44 ]. In addition, it is common to find S. pneuomoniae and S. aureus from specimens of sub periosteal abscess [ 44 ].…”

Left subperiosteal abscess with contralateral preseptal cellulitis: A case report

“…However, the incidence of rhinosinusitis in older children is relatively low. [4] Rahbar et al found that orbital subperiosteal abscess in children can be successfully and safely managed by a transnasal endoscopic approach in selected patients [2] . All patients with orbital cellulitis should be treated with intravenous antibiotics and to undergo endoscopic orbital decompression if there is abscess formation or visual impairment like our patient.…”

“…It was estimated that the incidence of subperiosteal abscess in orbital infection is about 15 % in children. [2] In the pre-antibiotic era, 20% of patients with periorbital cellulitis were documented with permanent loss of vision and 17% died from central nervous system complications. Nowadays, despite antimicrobial and surgical management, 15% to 30% of patients with an SPA develop various visual sequelae.…”

“…Nevertheless, even if preseptal cellulitis is presented, CT scan is recommended due to the rapid progression of the disease. [2] The orbital complications in paediatric rhinosinusitis are usually unilateral at presentation. However, in our patient, she is presented with left subperiosteal abscess with contralateral preseptal cellulitis which is an uncommon presentation.…”

“…The potential for loss of vision and the devastating morbidity associated with an SPA immediate surgical drainage is recommended when there is [1] impairment of vision, [2] worsening of the visual examination results (periorbital erythema or edema, proptosis, and restriction of gaze), [3] any sign of systemic manifestation or complication, [4] an inability to perform a reliable and serial ophthalmologic examination, [5] an immunocompromised patient, and…”