A pediatric case of acute sinusitis complicated with epidural abscess and sub-periosteal orbital abscess

Abstract

Sinonasal-related orbital infections and intracranial infections are severe complications of pediatric acute sinusitis, which can cause severe sequela and may be life threatening. Immediate surgical management is necessary in many cases; however, there are no defined guidelines for these complications. We report a case of acute sinusitis complicated with epidural abscess and sub-periosteal orbital abscess. The patient was a 9-year-old male. His left orbit showed severe swelling and he was unable to open the eye. Left eye movement was severely restricted in all directions. Computed tomography and dynamic magnetic resonance imaging revealed left sinusitis, left sub-periosteal orbital abscess and a small epidural abscess in the anterior skull base accompanied by an air bubble. We immediately performed endoscopic sinus surgery and made an external superior orbital rim incision. The orbital swelling and eye symptoms improved immediately after surgery. Since he had no neurological symptoms, conservative treatment was selected for the epidural abscess. Streptococcus anginosus was detected from nasal discharge and air bubbles in the epidural abscess indicated anaerobic bacterial infection. The epidural abscess was completely eliminated with the intravenous administration of ampicillin and metronidazole.