Abstract
IntroductionComplications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.Case presentationWe described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.ConclusionThe case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.
Highlights
Complications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.Case presentation: We described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity
The case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection
We report the case of a previously healthy 15-year-old girl affected by pansinusitis and subperiosteal orbital abscess following an acute Group A beta-haemolitic streptococcus (GAS) pharyngitis and successfully treated with functional endoscopic sinus surgery (FESS)
Summary
Our case focused the attention on:. – the possible spreading of a streptococcal pharyngeal infection towards the orbital involvement that may require a multispecialty emergency approach;. – the surgical management of subperiosteal orbital abscess that can by safely performed with FESS in young patients affected by of a subperiosteal abscess as a consequence of a streptococcal pharyngeal infection. Authors’ contributions FC drafted the manuscript and participated in the management of the case (oral and maxillofacial examination). RL, DT, GB, MB and GT participated in management of the case (respectively treating: RL the diagnosis and antibiotic therapy, DT the ophthalmic assessment and re-evaluation, GB the radiological investigation, MB the oral and maxillofacial examination, GT the surgical therapy) and in drafting the manuscript revising it critically. Author details 1Division of Oral Medicine, Department of Dental Sciences, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy.
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