SHM Converge Scientific Abstract ePoster Gallery-Atypical Presentation of Septic Cavernous Sinus Thrombosis in a 72-Year-Old Male

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This report describes a 72-year-old man with septic cavernous sinus thrombosis (CST), a rare but life-threatening complication of facial or dental infections. CST can occur when infection spreads retrograde through valveless facial and ophthalmic veins into the cavernous sinus. Typical symptoms include fever, headache, periorbital swelling, and cranial nerve dysfunction affecting nerves III, IV, V1, and VI.<br /><br />The patient presented with two weeks of progressive left facial pain, headache, fever, diplopia, photophobia, and periorbital swelling after recently completing antibiotics for a dental infection. Exam showed left ptosis, complete ophthalmoplegia, reduced corneal reflex, papilledema, and an erythematous, swollen eye with purulent discharge. Laboratory studies revealed marked leukocytosis. Although blood cultures were negative, abscess cultures grew coagulase-negative Staphylococcus, Actinomyces meyeri, and Streptococcus viridans.<br /><br />MRI with contrast confirmed left CST with surrounding inflammation, and CT showed facial edema and parotid enlargement. The patient was diagnosed with septic CST secondary to a facial abscess. He was treated with empiric broad-spectrum IV antibiotics, then narrowed to IV amoxicillin based on culture results. Therapeutic anticoagulation with low-molecular-weight heparin was started after contraindications were excluded. Supportive care and close neurologic monitoring were also provided.<br /><br />The patient improved within 72 hours, with resolution of fever and gradual recovery of eye function. He completed four weeks of IV antibiotics and three months of anticoagulation.<br /><br />This case highlights the importance of early recognition of CST in patients with facial infection and neurologic/ocular symptoms. Prompt imaging, broad-spectrum antibiotics, and selective anticoagulation can improve outcomes and prevent serious complications such as vision loss, stroke, and death.

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Jonathan D. Grube

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Author List Alessandra Cruz Bou, Anvesh Kodali Naga, Jonathan D. Grube, Kathleen Mattingly, Mitra Chandan, Rohit Nalamati, Sage Ben David, Stephanie Rivera Saavedra

Category Clinical Vignettes

Concept Cavernous Sinus Thrombosis

Concept Broad-Spectrum Intravenous Antibiotic Therapy

Concept Source Control

Concept Facial Infection

Concept Sinus Disease

Distinguished Non-Finalist

Presenter Organization UCF/HCA Ocala Internal Medicine Residency

Presenting Author Jonathan D. Grube

Track Adult

Keywords

septic cavernous sinus thrombosis

facial infection

dental infection

cranial nerve dysfunction

periorbital swelling

MRI contrast

broad-spectrum antibiotics

anticoagulation

Actinomyces meyeri

ophthalmoplegia

Cavernous Sinus Thrombosis

Broad-Spectrum Intravenous Antibiotic Therapy

Source Control

Facial Infection

Sinus Disease