Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection

Abstract

Background

Orbital cellulitis is an infectious disease that is very common in pediatric patients, in which severe complications may develop. Etiological agents related to this disease are Haemophilus influenzae B, Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis, 95% of the cases. Streptococcus beta-hemolytic and anaerobic microorganisms may also be present and cause < 5% of the cases. We present an uncommon case of orbital cellulitis complicated by a subperiosteal abscess caused Streptococcus pyogenes.

Case Report

A 9-year-old male patient with a history of attention deficit disorder and hyperactivity disorder since he was five years old. His illness started with erythema on the outer edge of the right eye, increase in the peri-orbicular volume with limitation of eyelid opening, progression to proptosis, pain with eye movements and conjunctival purulent discharge. Image studies reported a subperiosteal and pre-septal right abscess with extraocular cellulitis. Empirical antibiotic treatment was started, surgical drainage was performed, and Streptococcus pyogenes was isolated from the culture of the obtained purulent material.

Conclusions

Due to the implementation of vaccination schemes against H. influenza and S. pneumoniae since the 90s, the cases by these pathogens have decreased, causing new bacteria to take place as the cause of the infection. The importance of considering S. pyogenes as an etiology of orbital cellulitis comes from its rapid progression to abscess formation, and the few cases described in the literature.