Cavernous sinus thrombosis secondary to MRSA septicaemia

Abstract

Purpose: To report the first case of cavernous sinus thrombosis (CST) due to methicillin-resistant Staphylococcus aureus (MRSA) infection. Also, to emphasise that MRSA infection may be acquired in the community. Method: Single observational case report. Results: CST has a very high mortality and morbidity and has been reported as a rare complication of localised and systemic infection. We present the case of a 35-year-old female intravenous (IV) drug user presenting with septicaemia and heroin overdose. Following initial resuscitation, she gained consciousness but remained confused with Glasgow Coma Scale (GCS) of 8/15. The patient was febrile and there was a marked bilateral proptosis, eyelid swelling with erythema, and conjunctival chemosis. Pupils were pinpoint. Ocular movements appeared limited. In view of the high index of suspicion of CST, the patient was intubated for an urgent CT scan of the brain and orbits, which confirmed the disorder's diagnosis. Highdose IV ceftazadime, metronidazole, and flucloxacillin was commenced. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient had not had any prior hospital contact. The source of infection was not identified, but the subsequent CT scan indicated multiple intracerebral abscesses and multiple cavitating abscesses of the lungs with a large pleural effusion. The patient died nine days after admission to hospital. Conclusion: MRSA infection can be acquired in the community and should be borne in mind by ophthalmologists when dealing with infections. To the authors' knowledge, this is the first case of CST secondary to MRSA sepsis.