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Published on: March 17, 2014
Pseudomonas Aeruginosa: A Masquerader in Sino-Orbital Infections
Xi Chen1, Benjamin S Bleier, Daniel R Lefebvre
1*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.
Purpose:
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.
Insights
Pseudomonas sino-orbital infections can cause orbital cellulitis in immunocompromised patients. Early diagnosis and conservative treatment are key, especially when vision is preserved, avoiding radical surgery.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Otorhinolaryngology
Background:
- Pseudomonas aeruginosa is an opportunistic pathogen that can cause severe infections.
- Sino-orbital infections are rare but can lead to significant morbidity.
Observation:
- Two immunocompromised patients presented with sino-orbital infections and orbital cellulitis.
- Both patients exhibited eschar in the nasal passages and sinus cavities.
- Orbital imaging revealed erosion through the lamina papyracea in both cases.
Findings:
- Histopathology and cultures confirmed Pseudomonas infection in both patients.
- Despite orbital involvement, both patients maintained intact vision without optic neuropathy.
- Conservative sinus debridement was sufficient for treatment.
Implications:
- Pseudomonas sino-orbital infections should be considered in immunocompromised individuals with eschar and orbital wall erosion.
- Preserved vision in such cases suggests a bacterial etiology, potentially avoiding aggressive surgical interventions like orbital exenteration.
- This contrasts with invasive fungal diseases, which may necessitate more radical surgical approaches.
