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Sinogenic polymicrobial anaerobic orbital cellulitis: the importance of source control and broad empirical antibiotics
  1. Andrew Blunsum1,
  2. Clare Treharne2,
  3. Theofano Tikka3,
  4. Arunachalam Iyer2 and
  5. Elan Micha Tsarfati4
  1. 1Infectious Diseases & General Internal Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2Department of Ear, Nose and Throat, NHS Lanarkshire, Airdrie, UK
  3. 3Department of Otolaryngology, NHS Greater Glasgow and Clyde, Glasgow, UK
  4. 4Department of Microbiology, NHS Forth Valley, Larbert, UK
  1. Correspondence to Dr Elan Micha Tsarfati; elan.tsarfati{at}nhs.scot

Abstract

A man in his twenties with a history of recurrent sinusitis was urgently referred to the emergency department (ED) by an out-of-hours general practitioner following a 2-day history of increasing right eye pain, redness and swelling after a week of coryzal symptoms. He denied visual impairment and any history of recent dental pain or procedures. Initial assessment in ED noted fever, tachycardia and hypotension. Video consultation with ophthalmologist in the ED identified proptosis, periorbital erythema and chemosis with full eye movement solely affecting the right eye. Visual acuity of 6/6 was confirmed in both eyes. After review by the ear, nose and throat (ENT) team, a diagnosis of sinogenic right orbital cellulitis was made, empirical antibiotics started and care transferred to the ENT team for immediate surgical intervention. 48 hours postoperatively, the patient acutely deteriorated, developing ophthalmoplegia and visual acuity of 6/95 in the right eye. Repeat imaging demonstrated a deteriorating picture and urgent surgery was organised at a neighbouring hospital’s specialist ENT unit combined with a change to his antibiotics. On day 4, 1 day following transfer, an anaerobic bacterium, Eggerthia catenaformis, was isolated from blood cultures collected on admission. The patient improved clinically following the second surgery and targeted antimicrobial therapy, eventually being discharged 10 days after initial presentation. In addition to E. catenaformis, the Anaerobic Reference Unit (Cardiff) identified two further anaerobic bacteria, Parvimonas micra and Dialister pneumosintes. This paper presents the first documented case of polymicrobial anaerobic orbital cellulitis secondary to acute bacterial sinusitis. Moreover, this case underpins the importance of broad empirical antibiotics coupled with surgical source control to effectively manage a rare but sight-threatening and life-threatening disease.

  • Ear, nose and throat
  • Infections
  • Eye
  • Ear, nose and throat/otolaryngology
  • Infectious diseases

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Footnotes

  • Contributors ET: have been involved in the conception, drafting (writing the microbiology/antimicrobial related sections) and have edited/revised/proofread the manuscript, also act as the final approver and will remain accountable for the final article, and also the corresponding author. AB: wrote most sections of the manuscript, including developing tables, editing and proofreading. CT and TT: involved in writing the manuscript, specifically sections focused on ENT management. AI: involved in editing and providing clinical 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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

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