SHM Converge Scientific Abstract ePoster Gallery-Sb-Nose: A Case of Septic Cavernous Sinus Thrombosis as a Complication of an Nasogastric Tube

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This case describes a 75-year-old man with a history of diverticulitis who presented with nausea, vomiting, fever, confusion, and neck stiffness. He was initially treated for possible meningitis with vancomycin, meropenem, and acyclovir. Blood cultures grew gram-positive cocci in clusters, and inflammatory markers were elevated. Because of concern for a cavernous sinus process, MRI and CT venogram were obtained and showed bilateral cavernous sinus thrombosis with involvement of the superior ophthalmic veins, along with right sphenoid sinus opacification. He was started on a heparin drip and ENT/neurology were consulted. The following day, he developed abduction deficit, ptosis, and corkscrew conjunctival vessels, further supporting cavernous sinus thrombosis. He underwent urgent endoscopic sinus surgery, and cultures confirmed MRSA. His symptoms improved immediately after surgery, and he completed 6 weeks of vancomycin.<br /><br />The discussion highlights that Staphylococcus aureus is an uncommon cause of meningitis but is often associated with hospital-acquired infection and high mortality. It is also the most common cause of septic cavernous sinus thrombosis, usually arising from ethmoid or sphenoid sinusitis. Approximately 40% of patients with septic cavernous sinus thrombosis have concurrent meningitis, and overall mortality is 20–30%.<br /><br />In this patient, several factors likely predisposed him to infection, including a recent RSV infection, septal deviation, and placement of an NG tube. The case emphasizes that MRSA bacteremia should raise early concern for cavernous sinus thrombosis, even before classic gaze restriction develops.

Asset Subtitle

Nimit Gandhi

Meta Tag

Author List Ann Marie Kumfer, Emma Healy, Nimit Gandhi

Category Clinical Vignettes

Concept Cavernous Sinus Thrombosis

Concept Staphylococcus aureus

Concept Broad-Spectrum Antibiotic

Concept Sinus Disease

Concept Cranial Nerve Deficit

Distinguished Non-Finalist

Presenter Organization Univeristy of North Carolina

Presenting Author Nimit Gandhi

Track Adult

Keywords

cavernous sinus thrombosis

MRSA bacteremia

sphenoid sinusitis

septic cavernous sinus thrombosis

meningitis

vancomycin

endoscopic sinus surgery

superior ophthalmic vein thrombosis

Staphylococcus aureus

heparin drip

Cavernous Sinus Thrombosis

Staphylococcus aureus

Broad-Spectrum Antibiotic

Sinus Disease

Cranial Nerve Deficit