Streptococcus equi subsp. zooepidemicus and 'Neighbourhood syndrome' -extra-orbitocranial rhinosinusitis with reversible sudden loss of vision- a case report

Abstract

Background: Rhinosinusitis is a common condition which may present with complications commonly involving the orbit and the intracranial space. Loss of vision in the absence of clinical or radiological signs of involvement of the orbit and intracranium is rare and carries a high morbidity rate. Streptococcus equi subspecies zooepidemicus is not a well-documented cause of paranasal sinus infection.

Case presentation: We present a case of a 16 year old female patient who had unilateral loss of vision with signs of retrobulbar optic neuritis and no other neurological signs. We isolated an unusual organism- Streptococcus equi subspecies zooepidemicus from the maxillary sinus. Emergency endoscopic sinus surgery and antibiotic treatment resulted in complete reversal of the loss of vision.

Conclusion: The presence of paranasal sinus disease in association with loss of vision even in the absence of a clear link between the two should be treated as an emergency with surgical drainage and or appropriate antibiotic therapy. In patients presenting with suspected inflammatory orbital involvement, imaging of the orbit and paranasal sinuses should be considered early.

Keywords: Loss of vision; Rhinosinusitis; Streptococcus zooepidermicus.

Fig. 1

Coronal and axial contrast-enhaced CT demonstrates bilateral maxillary sinus, right ethmoidal, frontal and sphenoidal opacification. The superior ophthalmic veins were bilaterally enhancing with no filling defects. There was no caroto-cavernous sinus pathological enhancement seen. There were no retro-bulbar lesions noted or inflammatory changes noted

Fig. 2

Axial CECT on bone window settings demonstrates no evidence of bony destruction or unilateral widening of the optic canal. Pansinusitis noted