Orbital Cellulitis and Cavernous Sinus Thrombosis from Melioidosis : Case Report
Keywords:
orbital cellulitis, cavernous sinus thrombosis, melioidosisAbstract
A 34-year-old female patient with newly diagnosed diabetes mellitus type 2 presented with a three -day history of
high grade fever, severe headache and erythematous plaque along forehead. Ocular involvement included painful proptosis
of the right eye and restriction of ocular motility. The patient was administered with intravenous cetriaxone, clindamycin
and oral acyclovir for two days but clinical outcome was then worsening. Hemoculture subsequently reported Burkholderia
pseudomallei. Therefore, Ceftazidime was administered instead. MRI of the brain showed thrombophlebitis of bilateral
superior ophthalmic vein, cavernous sinus thrombosis and small epidural abscess in right frontal region. Surgical pus
drainage from skin abscess in forehead area was done and oral trimethoprim/sulfamethoxazole was used as a combined
treatment. Venous sinus thrombosis was initially treated with subcutaneous enoxaparin and then maintained with warfarin.
The clinical outcome was satisfactory with final visual acuity of 20/20 and completely healed forehead scar.
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