Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient.
BACKGROUND
Complications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.


METHODS
We described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.


CONCLUSIONS
The case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.
Division of Oral Medicine, Department of Dental Sciences, University of Trieste, Italy.
Fulvia
F
Costantinides
Roberto
R
Luzzati
Daniele
D
Tognetto
Gabriele
G
Bazzocchi
Matteo
M
Biasotto
Gian Carlo
GC
Tirelli
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D018450:Disease Progression; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054517:Orbital Cellulitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D010612:Pharyngitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003287:Contrast Media