A Case of Cavernous Sinus Thrombosis due to a Mistreated Facial Furuncle

ABSTRACT

Infections of the face, especially of the medial third or "the danger triangle", are the most frequent primary foci associated with thrombosis of cavernous sinus. Microorganisms entering the facial vein and pterygoid plexus from these sites are easily carried to the sinus through the ophthalmic vein. When the septic thrombosis involves various structures in the sinus, multiple clinical manifestations develop and if appropriate anti-infective therapy is not instituted timely, grave consequences with high mortality is possible. Recently, we experienced such a case. A five-year-old boy had high fever, proptosis, periorbital edema, chemosis and limitation of eye movements. Three days before admission, he had suffered from erythematous swelling spreading over the periorbital area, where simple steroid ointment containing no antibiotics had been applied after a furuncle on the nose had been squeezed. On admission, brain MRI revealed meningeal enhancement, high-signal densities in enlarged right cavernous sinus and narrowing of internal carotid artery. Analysis of cerebrospinal fluid showed bacterial meningitis and the cultures of blood and eye discharge proved to be Staphylococcus aureus. On massive antibiotic therapy, he recovered swiftly without any adverse sequelae. The authors report this case with a warning against wide-spread misuse of steroids and inadequate treatment of the mostly neglected, but once-dreaded minor infections on the face.