Severe Orbital Cellulitis Complicating Facial Malignant Staphylococcal Infection

Case Report

Austin J Clin Case Rep. 2020; 7(5): 1183.

Severe Orbital Cellulitis Complicating Facial Malignant Staphylococcal Infection

Chabbar Imane*, Serghini Louai, Ouazzani Bahia and Berraho Amina

Ophthalmology B, Ibn-Sina University Hospital, Morocco

*Corresponding author: Imane Chabbar, Ophthalmology B, Ibn-Sina University Hospital, Morocco

Received: October 27, 2020; Accepted: November 12, 2020; Published: November 19, 2020

Abstract

Orbital cellulitis represents a major ophthalmological emergency. Malignant staphylococcal infection of the face is a rare cause of orbital cellulitis. It is the consequence of the infectious process extension to the orbital tissues with serious loco-regional and general complications. We report a case of a young diabetic child, presenting an inflammatory exophthalmos of the left eye with purulent secretions with a history of manipulation of a facial boil followed by swelling of the left side of face, occurring in a febrile context. The ophthalmological examination showed preseptal and orbital cellulitis complicating malignant staphylococcal infection of the face. Orbito-cerebral CT scan showed a left orbital abscess with exophthalmos and left facial cellulitis. An urgent hospitalization and parenteral antibiotherapy was immediately started. Clinical improvement under treatment was noted without functional recovery. We emphasize the importance of early diagnosis and urgent treatment of orbital cellulitis before the stage of irreversible complications.

Keywords: orbital cellulitis, malignant staphylococcal infection of the face, management, blindness

Introduction

Malignant staphylococcal infection of the face is a serious skin disease. It can occur following a manipulation of a facial boil. It is revealed by a rapidly diffuse cellulitis of the face [1]. Its extension is frequent towards the orbital cellular tissues causing a serious orbital cellulitis of unpredictable evolution and threatening the visual or even vital prognosis.

We report a case of severe orbital cellulitis in a young child occurring after neglected malignant staphylococcal infection of face and we emphasize the importance of early diagnosis and urgent treatment before the stage of complications.

Case Report

We report a case of a young male child, 14 years old, diabetic since the age of 12 years treated by insulin injection therapy with poorly controlled type 2 diabetes. He was presented to the ophthalmological emergency for an inflammatory exophthalmos of the left eye with purulent secretions. The interrogation revealed the appearance of a boil of nasal localization 15 days previously, followed by a progressive installation of a facial swelling after a boil manipulation with a fever and reduced general condition.

On ophthalmological examination, the visual acuity of the left eye was no light perception. We noted an inflammatory eyelid edema with purulent secretions, chemosis, irreducible exophthalmos and ophthalmoplegia with afferent pupillary deficit (Figure 1). The fundus examination was difficult. The examination of the face noted an inflammatory swelling of the frontal and left side, painful on palpation. On general examination, the child was feverish at 39.5° with reduced general condition.

Orbito-cerebral CT scan revealed a left preseptal and orbital cellulitis complicated by an orbital abscess with exophthalmos (Figure 2a, b), and left facial cellulitis with frontal purulent collection (Figure 3a, b).

The diagnosis of orbital cellulitis complicating malignant staphylococcal infection of the face was retained on clinical and radiological arguments. An urgent medical treatment was started without waiting for microbiological analysis, based on parenteral antibiotherapy: Ceftriaxone 2g and Gentamicin 160 mg, puncture-drainage of the purulent collection and glycaemic control. A bolus of corticotherapy was indicated after obtaining apyrexia and controlling the infection. Local treatments, antibiotic eye drops and lubricants were prescribed to protect the cornea from exposure and secondary infection. The course after treatment was marked by the regression of inflammatory edema and exophthalmos. However, the evolution of visual function was unfavorable with optic atrophy and permanent blindness (Figure 4a, b, c).