TY - JOUR T1 - Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection JF - BMJ Case Reports DO - 10.1136/bcr.03.2009.1671 VL - 2009 SP - bcr0320091671 AU - Robin Gwynne Jones AU - Brendan Arnold Y1 - 2009/01/01 UR - http://casereports.bmj.com/content/2009/bcr.03.2009.1671.abstract N2 - The present report concerns a patient who presented with a 4-day history of left-sided facial pain arising from a pre-existing dental infection and progressive shortness of breath. The patient had a previous diagnosis of rheumatoid arthritis and was being treated with methotrexate. The rapid development of a right eye proptosis necessitated urgent decompression with a lateral canthotomy and cantholysis. Imaging revealed a left facial abscess, cavernous sinus thrombosis (CST), bilateral internal jugular thrombosis and multiple lung abscesses. Blood cultures yielded Streptococcus constellatus, a member of the Peptostreptococcus family. The patient was admitted to the intensive care unit (ICU) with respiratory failure and septic shock. She was treated with intravenous meropenem and clindamycin, and anticoagulated. Despite early intervention, the patient developed a middle cerebral artery infarct. Over a 3-week period she was gradually weaned from vasopressor and ventilatory support. ER -