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Case report
Septic cavernous sinus thrombosis in a paediatric patient with undiagnosed thrombophilia
  1. Shafee Salloum1,
  2. Joseph Bowens2,
  3. Jordan Wright3 and
  4. Elizabeth Ey4
  1. 1 Pediatric Hospital Medicine, Dayton Children's Hospital, Dayton, Ohio, USA
  2. 2 Dayton Children's Hospital, Dayton, Ohio, USA
  3. 3 Pediatric Hematology and Oncology, Dayton Children's Hospital, Dayton, Ohio, USA
  4. 4 Pediatric Radiology, Dayton Children's Hospital, Dayton, Ohio, USA
  1. Correspondence to Dr Shafee Salloum; salloums{at}childrensdayton.org

Abstract

A previously healthy 8-year-old girl presented to the hospital with right periorbital and forehead swelling in the setting of a 1-week history of upper respiratory symptoms. Contrast-enhanced CT revealed pansinusitis with orbital and frontal abscesses and thrombosis of the anterior portion of the superior sagittal sinus. She was treated with surgical drainage, antibiotics and anticoagulants. After 2 days she developed cranial nerve (CN) VI palsy. Contrast-enhanced MRI revealed small epidural abscess, right-sided thrombi of the cavernous sinus, internal carotid artery and internal jugular vein, in addition to the superior sagittal sinus. Thrombophilia workup revealed heterozygosity for factor V Leiden. She underwent 6 weeks of parental antibiotic therapy, 3 months of anticoagulation therapy and 7 days of steroids. With treatment, her visual acuity returned to baseline, CN VI palsy resolved and repeat imaging showed resolution of thrombi and epidural abscess, but persistent narrowing of the internal carotid artery.

  • paediatrics
  • ear, nose and throat/otolaryngology
  • haematology (incl blood transfusion)
  • ophthalmology
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Footnotes

  • Contributors SS and JB wrote the manuscript. JW reviewed and revised it. EE reviewed it and commented on the images.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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