Orbital Complication of a Paranasal Sinus Actinomycosis

Abstract

Objective: 1) Describe the first reported case of paranasal sinus actinomycosis associated with an orbital complication. 2) Describe other unusual features of the case: the occurrence of the infection in an immunocompetent pregnant patient, the involvement of the ethmoid sinus, the safety of a surgical treatment in a 15-week pregnant patient. Method: Case report of a 25-year-old woman, 15 weeks pregnant. Disease studied: Ethmoid sinus actinomycosis complicated by an subperiosteal orbital abscess. Setting: Tertiary referral university hospital. Intervention: Intravenous antibiotic therapy associated with a surgical treatment under general anesthesia. Outcome measurement: Safety and efficacy of the treatment. Results: The patient was admitted for treatment of the complicated rhinosinusitis. She immediately started intravenous antibiotic therapy with amoxicillin and clavulanic acid and a surgical drainage under general anesthesia was indicated. Risks for the patient and for the fetus were discussed and the informed consent was obtained for the anesthetic and for the surgical procedures. A combined external and transnasal endoscopic approach was performed to treat the infection. Actinomyces meyeri was isolated. The patient improved and was discharged after 14 days of medical treatment. Eight months after surgery the patient and her newborn are both well and no sequelae were registered. Conclusion: Actinomycosis of the paranasal sinus can involve primarily the ethmoid sinus, do not have a history of dental procedures or trauma, and result in orbital complications. Standard medical and surgical therapies for complicated rhinosinusitis are safe and effective, even in a pregnant patient.