Concurrent Pansinusitis and Orbital Cellulitis Complicated by Extensive Head and Neck Venous Thrombosis in an Unvaccinated Adolescent Patient with COVID-19: A Case Report

Abstract

Background: Orbital cellulitis is an infrequent but serious infectious complication of rhinosinusitis, most commonly seen in the pediatric population. Extension into the cavernous sinus, leading to further infection and thrombosis, is a rare but life-threatening complication. Although COVID-19 has been linked to an increased risk of venous thromboembolism, most cases involve extremity deep venous thrombosis or pulmonary embolism; reports of intracranial or jugular system thrombosis are rare.

Case report: We describe a case of a 17-year-old female patient with no significant medical history or thrombotic risk factors found to have orbital cellulitis and severe pansinusitis, complicated by multiple venous thromboses in the head and neck requiring emergent surgical intervention and pediatric intensive care admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Extensive head and neck venous thrombosis and intracranial abscesses are rare complications of pansinusitis and orbital cellulitis, and the thrombotic complications of COVID-19 are well documented. A delay in diagnosis and treatment can lead to potentially devastating consequences.

Keywords: COVID-19; Cavernous sinus thrombosis; Internal jugular vein thrombosis; Intracranial abscess; Orbital cellulitis; Pansinusitis; Pediatric; SARS-CoV-2; Streptococcus constellatus, Ophthalmic vein thrombosis.

Figure 1

Computed tomography scan of the orbit with i.v. contrast showing (A) right orbital cellulitis and proptosis (arrow), and (B) right internal jugular vein thrombosis (arrow) with significant bilateral pansinusitis.

Figure 2

Magnetic resonance image of (A) internal jugular vein thrombosis (arrow), proptosis, and abnormal enhancement of the right periorbital soft tissue; (B) distention of the right superior ophthalmic vein and lack of i.v. contrast enhancement (arrows) consistent with thrombosis. There is additional cavernous sinus and sigmoid sinus thrombosis, (C) abscesses within the right posterior orbit and right temporal lobe, and (D) right temporal lobe abscess, right subdural empyema, bilateral cavernous sinus thrombosis, and small left temporal lobe abscess.