title: Pseudomonas Aeruginosa: A Masquerader in Sino-Orbital Infections.
abstract: OBJECTIVE
  To report 2 immunocompromised patients with sino-orbital necrotizing pseudomonas infections and review the literature.
  
  
  METHODS
  This is a noncomparative, retrospective case series, and review. The clinical data of 2 patients with histopathologic and microbiologic diagnoses of pseudomonas sinus infections causing orbital cellulitis were obtained from medical records. A retrospective literature review was performed on all reported cases of periorbital pseudomonas infections.
  
  
  RESULTS
  One patient with acquired immune deficiency syndrome was noted to have orbital cellulitis with clear visualization of eschar in the middle turbinate on nasal endoscopy. A second patient also had orbital cellulitis with ophthalmoplegia and presence of eschar in the sinus. Both patients had some degree of erosion through the lamina papyracea found on orbital imaging and both had intact vision without optic neuropathy. Pseudomonas infection was confirmed in both cases with permanent histopathology and cultures from conservative sinus debridement.
  
  
  CONCLUSIONS
  Pseudomonas sino-orbital infections must be considered in the differential diagnosis in cases of eschar and orbital wall erosion especially when vision is preserved in immunocompromised individuals. This finding obviates the need for radical debridement including orbital exenteration, which can be indicated in cases of invasive fungal disease.
authors.affiliation: *Department of Ophthalmology, †Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; and ‡Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Lefebvre
authors.forename: Nahyoung Grace
authors.initials: NG
authors.lastname: Lee
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis* / Q000382:microbiology; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000382:microbiology; D011552:Pseudomonas Infections / Q000175:diagnosis* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed