Persistent Fever in Bilateral Septic Cavernous Sinus Thrombosis: A Case Report

Septic cavernous sinus thrombosis (SCST) is a rare and life-threatening condition characterized by thrombus formation within the cavernous sinus, typically resulting from the spread of infection from facial, paranasal sinus, or dental origins. We report the case of a middle-aged man with a history of methicillin-resistant Staphylococcus aureus (MRSA) skin infections who presented with severe neck pain, fever, and bilateral eye swelling. The patient was bacteremic with MRSA and found on imaging to have thickening of extraocular muscles and air-fluid levels present within the sphenoid sinuses. Despite aggressive antibiotic and anticoagulant therapy, the patient's condition deteriorated. Imaging showed extensive intracranial thromboses involving the cavernous sinuses. Given the lack of clinical improvement and persistent bacteremia, otolaryngological surgical intervention was undertaken. Post-surgery, the patient showed marked improvement, underscoring the critical role of source control in managing SCST. This case highlights the importance of considering surgical options in the treatment of SCST to prevent severe complications and improve patient outcomes.