Community-Associated Methicillin-Resistant Staphylococcus aureus: Case Report of Acute Sinusitis With Orbital Extension in a Pregnant Lady

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant burden on healthcare. Acute sinusitis can be one of its deadliest presentations as it can quickly lead to orbitocranial extension with complications including blindness, brain abscess and death. Previously believed to affect immunocompromised individuals only, community-associated MRSA is now known to affect healthy individuals too. The seriousness of MRSA infection increases manifold when the infection occurs in pregnant women who are immune modulated. We present a case of a 34-year-old pregnant lady who presented with a severe headache for two days. She had acute sinusitis that involved right orbit in less than 24 hours. She was promptly managed with intravenous antibiotics and drainage of abscess that revealed MRSA. Fortunately, the patient made a complete recovery. The purpose of this case report is to emphasize on keeping a high index of suspicion of MRSA for all soft tissue infections. Early recognition, proper evaluation and timely and appropriate treatment can prove lifesaving.

Keywords: headache; methicillin-resistant staphylococcus aureus; mrsa; sinusitis.

Figure 1. Orbital Cuts of MRI Brain

almost complete opacification involving the right maxillary (solid yellow arrows) and bilateral ethmoid (yellow dotted arrows) sinuses, appearing (A) hypointense on T1 and (B, C) hyperintense on T2-weighted images. (D) There is mass effect causing slight proptosis of the right eyeball with preorbital soft tissue swelling (solid white arrow). MRI: magnetic resonance imaging