Bilateral intraorbital abscesses with intracranial complications in a young Cameroonian girl: a case report

Abstract

Oumarou Abdouramani,1 S Nguefack,2,3 VA Dohvoma,3 B Moifo,3,5 André Omgbwa Eballé,1 A Moho,4 E Epee,3 E Mbonda,2,3 AL Bella31Ophthalmology Unit, Yaoundé Gynaeco-obstetric and Paediatric Hospital (YGOPH), 2Neuropaediatric Unit, YGOPH, 3Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, 4Ear, Nose, and Throat Unit, YGOPH, 5Radiology Unit, YGOPH, CameroonBackground: Intraorbital abscess is a very severe infection with ophthalmologic and neurologic complications that are sometimes life-threatening.Objective: To report the etiologic, clinical, radiologic, and prognostic features of one case of bilateral intraorbital abscesses with intracranial complications.Case report: A 15-year-old Cameroonian girl in a comatose state (11/15 on the Glasgow Coma Scale) with meningeal signs, right hemiplegia, right facial palsy, and bilateral exophthalmia was admitted for meningitis and cerebral abscess secondary to orbital cellulitis. A lumbar tap was carried out, no organisms were seen by Gram stain, and culture was negative due to previous antibiotic therapy. A computed tomography scan showed a left internal capsule infarct and a pansinus opacification. Bilateral superior orbitotomies were performed and the abscess evacuated. Microscopy and culture of surgical material were negative. The patient was discharged 4 weeks after hospital admission with a visual acuity of 0.1 in both eyes, aphasia, and right hemiplegia. Nine months later, there was complete visual recovery (visual acuity 1.0 in both eyes). Anterior and posterior segments were normal on slit-lamp examination. There was no aphasia, but right-sided hemiparesis persisted.Conclusion: The authors emphasize the need for prevention, early diagnosis, and adequate treatment of orbital cellulitis in order to avoid complications.Keywords: intraorbital abscess, orbital cellulitis, orbitotomies, hemiparesis, intracranial complications, pansinusitis