Infective Endocarditis Presenting as Bilateral Orbital Cellulitis: An Unusual Case.

Talal Asif,Rebecca R Pauly,Rehman Ukani,Badar Hasan

doi:10.7759/cureus.1350

Abstract

Orbital cellulitis is a severe and sight-threatening infection of orbital tissues posterior to the orbital septum. The most common causes of orbital cellulitis are rhinosinusitis, orbital trauma, and surgery. Infective endocarditis (IE) is a systemic infection that begins on cardiac valves and spreads by means of the bloodstream to peripheral organs. Septic emboli can spread to any organ including the eyes and can cause focal or diffuse ophthalmic infection. Ocular complications of IE classically include Roth’s spots, subconjunctival hemorrhages, chorioretinitis, and endophthalmitis. IE as a cause of orbital cellulitis has been described by only one author in the literature. Here, we present a very rare case of bilateral orbital cellulitis caused by IE. Through this case, we aim to create awareness of the potential for serious ocular complications in IE and provide an overview of the management.

Highlights

In spite of the advances in medical and surgical treatment modalities, infective endocarditis (IE) continues to be associated with high morbidity and mortality [1]
Association of orbital cellulitis and infective endocarditis has been described in the literature once by Bakshi, et al who noted the association on the retrospective review of magnetic resonance imaging (MRI) of the head of 12 patients [5]
We present a very rare case of a patient admitted with fulminant bilateral orbital cellulitis and cavernous sinus thrombosis eventually diagnosed with Infective endocarditis (IE)

Summary

Introduction

In spite of the advances in medical and surgical treatment modalities, infective endocarditis (IE) continues to be associated with high morbidity and mortality [1]. The very day, the patient began to develop progressively increasing bilateral eyelid swelling, severe retroorbital headache with subjective chills and fever. The CT scan of the face was obtained that showed bilateral proptosis with stranding of the surrounding fat concerning for orbital cellulitis. The patient underwent urgent magnetic resonance imaging (MRI) of the brain, orbits and soft tissues of the neck which showed extensive bilateral orbital cellulitis and proptosis (Figure 1), enhancement of the leptomeninges concerning for basilar meningitis and retropharyngeal abscess (Figure 2). Antibiotics were switched to IV Nafcillin in the context of identification of the pathogen and for better central nervous system (CNS) penetration At this point, it was concluded by the multidisciplinary team that patient’s IV drug abuse had contributed to native tricuspid valve acute infective endocarditis.

Discussion

Conclusions

Findings

Disclosures