Unusual cause of acute sinusitis and orbital abscess in COVID-19 positive patient: Case report

Abstract

Background: Peptoniphilus indolicus is not usually seen in the eye or paranasal sinuses but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and other unusual complications are possible with such unsuspected bacteria.

Case presentation: The patient is a 76-year-old white male from a nursing home tested positive for COVID-19 and was sent from a nursing facility for left eye drainage and psychiatric evaluation. Upon presentation, the patient was not fully oriented and could not provide a history of the eye drainage. CT scan showed sinusitis with left orbital and periorbital abscess formation, cellulitis, and extensive osteomyelitis. He underwent endoscopic transnasal drainage and orbiotomy. Cultures returned positive for methicillin-resistant Stapholococcus aureus (MRSA), Streptococcus constellatus, and Peptoniphilus indolicus. He was maintained on several days of IV antibiotics and returned to the nursing home. He then presented 2 months later and required enucleation of his globe, due to the presence of multiple scleral perforations in the setting of orbital abscess, as well as removal of necrotic orbital bone.

Conclusions: Given the concomitant infection with COVID-19 and unusual presentation, the patient's sinus cultures support the notion that COVID-19 can affect the presence of bacteria within certain anatomical regions. Specifically, Peptoniphilus indolicus is not normally found outside of the vagina or gut biome. Avascular, pale mucosa and bone of the nasal cavity was noted during surgery of this COVID-19 infected patient, which is in contrast to the friable and edematous tissue typically found in acutely infected sinuses. Our patient's orbital abscess began to drain spontaneously through the skin, which is rare for orbital abscesses. Also uncommon with orbital abscesses is the need for enucleation, which in this case was deemed necessary given that the abscess had perforated the sclera in multiple locations.

Keywords: COVID-19; Case report; Orbital abscess; Peptoniphilus indolicus; Sinusitis.

Fig. 1

Axial sinus CT.

Fig. 2

Coronal Sinus CT.

Fig. 3

Sagittal Sinus CT.

Fig. 4

Endoscopic view of avascular tissue of the left middle meatus. Diamond – left middle turbinate, Star – left maxillary os.

Fig. 5

Orbital abscess drainage – eye open.

Fig. 6

Orbital abscess drainage – eye closed.

Fig. 7

Preoperative exam before second surgery.

Fig. 8

Repair of medial cheek wound as well as enucleation defect.

Fig. 9

Necrotic maxilla of medial inferior orbit.