Preseptal cellulitis and cerebral venous sinus thrombosis complication in a patient with diabetes mellitus

  • Sylves Patrick Surgical Based Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah
  • Huwaina Abdul Satar Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
  • Wan Hazabbah Wan Hitam Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
Keywords: cellulitis, diabetes mellitus, intracranial thrombosis, venous thrombosis
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Abstract

This was a rare case of preseptal cellulitis with an unexpected complication by cerebral venous sinus thrombosis. A 73-year-old woman with poorly controlled diabetes mellitus presented with a week history of swelling and redness on the left upper eyelid and right forehead, associated with poor oral intake, lethargy, and fever. She was generally lethargic with poor verbal response. She had cellulitis of the left upper eyelid and right forehead with the left upper eyelid necrosis. Computed tomography venography of the brain revealed thrombosis of the right transverse sinus, right sigmoid sinus, and right internal jugular vein. She later developed left upper eyelid and right forehead abscesses. Incision, drainage, and wound debridement were performed. She was treated with intravenous antibiotics and anticoagulant. After 1 week of treatment, the preseptal and forehead cellulitis had resolved. However, she passed away due to aspiration pneumonia with respiratory failure on day-13 of hospitalization.

Author Biographies

Huwaina Abdul Satar, Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia

Ophthalmologist, Department of Ophthalmology

Wan Hazabbah Wan Hitam, Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia

Lecturer and Consultant Neuroophthalmologist, Department of Ophthalmology

References

  1. Spires JR, Smith RJ. Bacterial infections of the orbital and periorbital soft-tissues in children. Laryngoscope. 1986;96(7):763-7. https://doi.org/10.1288/00005537-198607000-00012

  2. Smith TF, O'Day D, Wright PF. Clinical implications of preseptal (periorbital) cellulitis in childhood. Pediatrics. 1978;62(6):1006-9. https://doi.org/10.1542/peds.62.6.1006

  3. Zellers TM, Donowitz LG. Brain abscess and ethmoid sinusitis presenting as periorbital cellulitis in a two-month-old infant. Pediatr Infect Dis J. 1987;6(2):213-5. https://doi.org/10.1097/00006454-198702000-00016

  4. Jones H, Trinidade A, Jaberoo MC, Lyons M. Periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis: a rare combination of complications arising from unilateral frontal sinusitis. J Laryngol Otol. 2012;126(12):1281-3. https://doi.org/10.1017/S0022215112002228

  5. Liu IT, Kao SC, Wang AG, Tsai CC, Liang CK, Hsu WM. Preseptal and orbital cellulitis: a 10-year review of hospitalized patients. J Chin Med Assoc. 2006;69(9):415-22. https://doi.org/10.1016/S1726-4901(09)70284-9

  6. Rayfield EJ, Ault MJ, Keusch GT, Brothers MJ, Nechemias C, Smith H. Infection and diabetes: the case for glucose control. Am J Med. 1982;72(3):439-50. https://doi.org/10.1016/0002-9343(82)90511-3

  7. Rao VA, Hans R, Mehra AK. Pre-septal cellulitis--varied clinical presentations. Indian J Ophthalmol. 1996;44(4):225-7.

  8. Aldemir-Kocabaş B, Karbuz A, Özdemir H, Çiftçi E, İnce E. Periorbital and orbital cellulitis: from presentation to outcome. J Pediatr Inf. 2014;8(4):148-52. https://doi.org/10.5152/ced.2014.1815

  9. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke. 2004;35(3):664-70. https://doi.org/10.1161/01.STR.0000117571.76197.26

  10. Sasiadek MJ, Sosnowska-Pacuszko D, Zielinska M, Turek T. Cerebral venous thrombosis as a first presentation of diabetes. Pediatr Neurol. 2006;35(2):135-8. https://doi.org/10.1016/j.pediatrneurol.2006.01.010

  11. Bialo SR, Agrawal S, Boney CM, Quintos JB. Rare complications of pediatric diabetic ketoacidosis. World J Diabetes. 2015;6(1):167-74. https://doi.org/10.4239/wjd.v6.i1.167

  12. Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral venous sinus thrombosis risk factors. Int J Stroke. 2009;4(2):111-23. https://doi.org/10.1111/j.1747-4949.2009.00260.x

  13. Ott EO, Lechner H, Aranibar A. High blood viscosity syndrome in cerebral infarction. Stroke. 1974;5(3):330-3. https://doi.org/10.1161/01.STR.5.3.330

  14. Levi M, van der Poll T, Schultz M. New insights into pathways that determine the link between infection and thrombosis. Neth J Med. 2012;70(3):114-20.

  15. Weill-Engerer S, Meaume S, Lahlou A, Piette F, Saint-Jean O, Sachet A, et al. Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study. J Am Geriatr Soc. 2004;52(8):1299-304. https://doi.org/10.1111/j.1532-5415.2004.52359.x

  16. Galili O, Mannheim D, Rapaport S, Karmeli R. A novel intermittent mechanical compression device for stasis prevention in the lower limbs during limited mobility situations. Thromb Res. 2007;121(1):37-41. https://doi.org/10.1016/j.thromres.2007.02.015

  17. Zhang J, Stringer MD. Ophthalmic and facial veins are not valveless. Clin Exp Ophthalmol. 2010;38(5):502-10. https://doi.org/10.1111/j.1442-9071.2010.02325.x

  18. Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous thrombosis: a practical guide. Pract Neurol. 2020;20(5):356-67. https://doi.org/10.1136/practneurol-2019-002415

  19. Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost. 2018;16(10):1918-31. https://doi.org/10.1111/jth.14210

  20. Khatri IA, Wasay M. Septic cerebral venous sinus thrombosis. J Neurol Sci. 2016;362:221-7. https://doi.org/10.1016/j.jns.2016.01.035

  21. Kojan S, Al-Jumah M. Infection related cerebral venous thrombosis. J Pak Med Assoc. 2006;56(11):494-7.

  22. Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203-13. https://doi.org/10.1111/ene.13381

  23. Ferro JM, Canhão P, de Sousa DA. Cerebral venous thrombosis. Presse Med. 2016;45(12 PT 2):e429-50. https://doi.org/10.1016/j.lpm.2016.10.007

  24. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Rep. 2013;1(3):187-96. https://doi.org/10.1007/s40141-013-0017-y

Published
2022-04-22
How to Cite
1.
Patrick S, Satar HA, Wan Hitam WH. Preseptal cellulitis and cerebral venous sinus thrombosis complication in a patient with diabetes mellitus. Med J Indones [Internet]. 2022Apr.22 [cited 2022Oct.8];31(1):75-9. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/5568
Section
Case Report/Series