A Rare Case of Orbital Cellulitis with Tolosa-Hunt Syndrome Caused by Methicillin-Resistant Staphylococcus aureus (MRSA): a Case Report

Putu Evindya Vipascitadewi Nandanaya Bharata, Nyoman Suryawati, Ratih Vibriyanti Karna, P. Duarsa, Gusti Ayu Indah Triana Juliari
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Abstract

Background: Orbital cellulitis is an active infection of the orbital soft tissue posterior to the orbital septum, which can cause Tolosa-Hunt Syndrome (THS) complication. Purpose: We reported a child with orbital cellulitis with THS complication caused by methicillin-resistant Staphylococcus aureus (MRSA). Case: A two-year-old girl complained of swelling and pain in the left eye accompanied by fever. In nasal region and left eye showed multiple erythema patches with geographic shape, size 1x2cm - 4x5cm, unclear border, erosion with sizes 0.5x1cm - 1x1.5 cm size covered with blackish crusts. After several days of hospitalization, she complained of proptosis and pain in moving her eye. We did the magnetic resonance imaging (MRI) scan examination, which showed a mass size of 2.2 x1.1 x 0.9 cm in a left intraconal orbital and dilation of the left-sided cavernous sinus. The blood culture showed MRSA bacteria. She was diagnosed with orbital cellulitis with THS complication and showed a good response with Meropenem, Methylprednisolone, cendo lyteers eye drops, levofloxacin eye drops, and gentamicin eye ointment. Discussion: Orbital cellulitis presents as ill-defined erythema, edema, warmth, and pain around the nasal and the orbital region and is more often found in children. The THS complication is characterized by ophthalmoplegia, unilateral orbital or periorbital pain, unilateral headache, and leukocytosis. Orbital cellulitis management includes antibiotic intravenous, corticosteroid, and eye care. Conclusion: THS is a rare complication of orbital cellulitis. Early diagnosis and management of orbital cellulitis are essential to prevent THS complication.
耐甲氧西林金黄色葡萄球菌(MRSA)致眼眶蜂窝织炎伴Tolosa-Hunt综合征1例
背景:眶蜂窝织炎是一种眶隔后方眶软组织的活动性感染,可引起Tolosa-Hunt综合征(THS)并发症。目的:我们报告了一例由耐甲氧西林金黄色葡萄球菌(MRSA)引起的眼眶蜂窝织炎患儿并发三手呼吸道并发症。病例:一名两岁女童主诉左眼肿痛伴发热。鼻区及左眼多发地理形状红斑,大小为1x2cm ~ 4x5cm,边界不清,糜烂,大小为0.5x1cm ~ 1x1.5 cm,覆盖黑色结痂。住院几天后,她抱怨眼球突出,移动眼睛疼痛。我们做了磁共振成像(MRI)扫描检查,显示左侧眶内肿块大小为2.2 x1.1 x 0.9 cm,左侧海绵窦扩张。血培养显示MRSA细菌。她被诊断为眼眶蜂窝组织炎并伴有三眼综合征,并在美罗培南、甲基强的松龙、cendo lyteers滴眼液、左氧氟沙星滴眼液和庆大霉素眼膏治疗后表现良好。讨论:眼眶蜂窝织炎表现为鼻腔和眼眶周围的红斑、水肿、发热和疼痛,多见于儿童。三眼综合征的特点是眼麻痹、单侧眶或眶周疼痛、单侧头痛和白细胞增多。眼眶蜂窝织炎的治疗包括静脉注射抗生素、皮质类固醇和眼部护理。结论:眼蜂窝织炎是一种罕见的并发症。眼窝蜂窝织炎的早期诊断和处理是预防三手关节炎并发症的关键。
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