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Open Access Case report

Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient

Fulvia Costantinides1, Roberto Luzzati2, Daniele Tognetto3, Gabriele Bazzocchi4, Matteo Biasotto1* and Gian Carlo Tirelli5

Author Affiliations

1 Division of Oral Medicine, Department of Dental Sciences, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy

2 Department of Infectious Diseases, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy

3 Department of Ophthalmology, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy

4 Department of Radiology, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy

5 Department of Head and Neck Surgical Sciences, Strada di Fiume 447, University of Trieste, Trieste 34149, Italy

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Head & Face Medicine 2012, 8:28  doi:10.1186/1746-160X-8-28

Published: 16 October 2012

Abstract

Introduction

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.

Case presentation

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.

Conclusion

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.

Keywords:
Group-A streptococcal pharyngitis; Orbital abscess; Functional endoscopic sinus surgery; Visual acuity; Dental examination