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

Ryan Clydesdale¹, Katelyn Stoker², Susan Bannon¹

¹Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA.

|October 21, 2024

Summary

Septic cavernous sinus thrombosis (SCST) is a rare infection. Surgical source control improved a patient with MRSA bacteremia and SCST when antibiotics failed.

Keywords:

mrsa bacteremia otolaryngological surgery septic cavernous sinus thrombosis source control sphenoidal sinusitis

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Area of Science:

Infectious Diseases
Neurosurgery
Otolaryngology

Background:

Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition.
It often arises from infections spreading from the face, sinuses, or teeth.

Observation:

A middle-aged man with a history of MRSA skin infections presented with fever, neck pain, and bilateral eye swelling.
Imaging revealed MRSA bacteremia, extraocular muscle thickening, and air-fluid levels in the sphenoid sinuses.
The patient's condition worsened despite aggressive antibiotic and anticoagulant therapy, with imaging showing extensive intracranial thromboses.

Findings:

Surgical intervention by otolaryngology was performed due to lack of clinical improvement and persistent bacteremia.
Post-surgery, the patient demonstrated significant improvement, highlighting the importance of source control.

Implications:

This case underscores the critical role of surgical source control in managing SCST.
Considering surgical options may be vital for preventing severe complications and improving outcomes in SCST patients.
Early and aggressive management, including source control, is essential for this dangerous condition.