Bilateral intraorbital abscesses and cavernous sinus thromboses secondary to Streptococcus milleri with a favorable outcome.
A 51-year-old woman with left proptosis, diplopia, headache, and nausea was found to have bilateral intraorbital abscesses, left superior ophthalmic vein thrombosis, bilateral cavernous sinus thromboses, and a left temporal lobe intracerebral abscess. Because the paranasal sinuses were unaffected, a dental origin was suspected and confirmed. The causative organism was Streptococcus milleri. Aggressive surgical intervention included bilateral orbital abscess drainage and dental extraction, and medical therapy included intravenous metronidazole, ceftriaxone, heparin, and methylprednisolone. A left sixth cranial nerve paresis was the only long-term sequela.
Udaondo
Patricia
P
Hospital General de Valencia, Valencia, Spain. patyudaondo@hotmail.com
Garcia-Delpech
Salvador
S
Díaz-Llopis
Manuel
M
Salom
David
D
Garcia-Pous
Maria
M
Strottmann
James M
JM
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; 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; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D034364:Streptococcus milleri Group / Q000302:isolation & purification*; D014081:Tooth Extraction; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents