Bilateral cavernous sinus thromboses and intraorbital abscesses secondary to Streptococcus milleri.
OBJECTIVE
To report the first case of bilateral cavernous sinus thromboses and bilateral intraorbital abscesses secondary to Streptococcus milleri.


METHODS
Single interventional case report.


METHODS
The findings of the ophthalmic evaluation, radiographic imaging, medical and surgical intervention, specimen cultures, and clinical course were analyzed.


RESULTS
A 17-year-old female had bilateral proptosis, decreased vision in the left eye, and altered mental status at presentation. An orbital compartment syndrome developed in the left eye and purulent material was present after lateral canthotomy, suggestive of an intraorbital abscess. Magnetic resonance imaging (MRI) scans revealed bilateral cavernous sinus thromboses, and subsequent computed tomographic (CT) scans revealed bilateral intraorbital abscesses in the setting of acute ethmoid and sphenoid sinusitis. Antibiotic treatment and surgical drainage of the orbital abscess and sinuses was performed, and specimen cultures revealed S. milleri. After surgery, the patient experienced hearing loss and a right internal capsule infarct, in addition to complete vision loss in the left eye. A second intraorbital abscess developed in the right eye and was drained surgically. The vision remained 20/20.


CONCLUSIONS
Streptococcus milleri is a virulent organism with a propensity to form abscesses in multiple areas of the body and should be considered as a possible etiologic agent in abscess formation of the orbit and cavernous sinus thrombosis.
Watkins
Lynnette M
LM
Ophthalmic Plastic, Orbital, Reconstructive and Cosmetic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Pasternack
Mark S
MS
Banks
Michelle
M
Kousoubris
Philip
P
Rubin
Peter A D
PA
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020226:Cavernous Sinus Thrombosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D015521:Ethmoid Sinusitis / Q000382:microbiology; D005094:Exophthalmos / Q000175:diagnosis; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015524:Sphenoid Sinusitis / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D034364:Streptococcus milleri Group / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents