Septic cavernous sinus thrombosis secondary to a mycotic pseudoaneurysm of a cubital arteriovenous fistula

Abstract

Introduction: The cavernous sinuses are part of the dural sinuses. In 1831, Bright described cavernous sinus thrombosis (CST) as a complication of epidural and subdural infections. Cavernous sinus thrombosis usually results as a complication of paranasal sinus infection or infections of the face, in an area called the 'danger triangle', trauma, bacteremia or ear infections. Case Report: A 35-year-old female presented with one month history of high grade fever and progressively increasing periorbital swelling. This presentation was preceded by failure and infection of her arteriovenous fistula (AVF) three weeks beforehand, which was resistant to medical therapy. On examination, she was febrile and had periorbital swelling with bilateral closure of the eyes. The left jugular vein was distended. At the site of the AVF, there was a pulsatile swelling which was also discharging pus. Following aneurysmectomy and AVF ligation, an angiogram of the head and neck showed a long segment occlusion on the left internal jugular vein extending to the left brachiocephalic vein plus a cavernous sinus thrombus. A diagnosis of a septic CST was made and management was conservative. We report this case because, to the best of our knowledge, no literature was found describing a mycotic AVF complicated by a jugular and brachiocephalic vein thrombosis causing a septic CST. Conclusion: In patients presenting with a mycotic AVF, the risk of developing a septic CST should be kept in mind. The goal of intervention should be to control the source of infection and prevent complications.