Subperiosteal Orbital Abscess Complicated by Haemophilus influenzae Type c Bacteremia in a Fully Immunized Toddler: A Brief Clinical Study

Subperiosteal orbital abscess (SPOA) is a serious complication of acute rhinosinusitis in children and may lead to visual loss or intracranial extension. The authors report a 20-month-old immunocompetent girl, fully immunized including Haemophilus influenzae type b (Hib) vaccine, who developed SPOA associated with H. influenzae type c (Hic) bacteremia. She presented with fever, rhinorrhea, and rapidly progressive swelling of the left upper eyelid. Contrast-enhanced magnetic resonance imaging demonstrated a superior SPOA. Because of the risk of visual compromise, emergent external drainage through a subbrow incision was performed, and a purulent subperiosteal collection was irrigated and drained with a Penrose drain. Empirical meropenem and vancomycin were de-escalated to cefazolin and then oral amoxicillin for a total of 28 days after blood cultures yielded Hic. Eyelid swelling resolved, extraocular movements fully recovered, and no recurrence was observed.