A case of orbital apex syndrome due to Pseudomonas aeruginosa infection.

Takeshi Kusunoki,Kaori Kase,Katsuhisa Ikeda

doi:10.4081/cp.2011.e127

Abstract

Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman) of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body.

Highlights

Orbital apex syndrome involves the optic nerve and structures in the apex of the orbita within the superior orbital fissures, including the nerves to the extraocular muscles and the first division of the trigeminal nerve.[1]
Case reports of orbital apex syndrome due to Pseudomonas aeruginosa infection have been very rare
We present a case of orbital apex syndrome with left pansinusitis caused by Pseudomonas aeruginosa infection based on bacteria culture and postoperative pathologic examination, and treated by endoscopic sinus surgery

Summary

Introduction

Orbital apex syndrome involves the optic nerve and structures in the apex of the orbita within the superior orbital fissures, including the nerves to the extraocular muscles and the first division of the trigeminal nerve.[1] This syndrome has been considered to have a poor prognosis.[2] Many studies have reported that this syndrome is caused by paranasal sinus mycosis.[1,2,3,4,5,6] case reports of orbital apex syndrome due to Pseudomonas aeruginosa infection have been very rare. In Japan, such a case has not been reported. We present a case of orbital apex syndrome with left pansinusitis caused by Pseudomonas aeruginosa infection based on bacteria culture and postoperative pathologic examination, and treated by endoscopic sinus surgery

Case Report

Discussion