Diagnosis at first glance: periorbital swelling and visual loss in an HIV-infected patient

Abstract

A 49-year-old HIV-infected man (category B2) was admitted to our hospital with periorbital swelling, fever and malaise. Six days before admittance he suiered mild left eyebrow trauma. Three days later he developed palpebral swelling and ocular pain and was transferred to the emergency room of our hospital, where he was diagnosed as having preseptal cellulitis with a normal paranasal sinus X-ray ¢lm.Treatment with oral amoxycillin^clavulanate was prescribed.The eyebrowwound was sutured but no visual evaluation was performed because the patient could not open the eye. He returned to the emergency room due to worsening of his condition. Clinical examination revealed severe ocular pain associated with chemosis, proptosis, amaurosis and periorbital swelling (Figure1). A head CTscanwas performed. Q U E S T I O N S