Ethmoïdite aiguë compliquée d’un abcès rétro-oculaire chez un enfant de 13 ans

Acute ethmoiditis complicated by intraorbital abscess, orbital cellulitis, and cerebral empyema in a 14‐year‐old girl

“…3,13,16 In this case, antibiotic therapy with ceftriaxone, ciprofloxacin, gentamycin, metronidazole, and drainage of the intraorbital abscess were used. Orbital and subperiosteal abscesses, as well as orbital cellulitis, are the complications of ethmoidomaxillary sinusitis found by several authors, 2,6,17 but in this study, the medial frontal cerebral empyema and focal signs were found beyond the orbital cellulitis and the Chandler IV retro-orbital abscess, and this would be explained by the indirect propagation of the infection by the hematogenous route through the ophthalmic veins without valves. In our study, blood culture before starting antibiotic therapy and the search for soluble antigens would have increased the probability of identifying the germ in our study.…”

“…Our patient's clinical picture (high fever of 39.9°C, painful swelling, and protrusion of the left eye for several days the following nasopharyngitis) indicated this from the first day of hospitalization 7–12 . Inflammation with hyperleukocytosis remains an observation in several studies 6,13 . According to Chandler, most of the authors recommend empirical broad‐spectrum antibiotic therapy by the intravenous route, combining third generation cephalosporins or amoxicillin/clavulanic acid with quinolones, aminoglycosides, and imidazoles, depending on the stage of the disease 1,6,14,15 …”

“…The clinic was dominated by a fever of 39.9°C, headache, a sensitive swelling of the left upper eyelid and the external canthus, chemosis, left exophthalmos with preservation of ocular mobility and visual acuity (10/10), a normal eye fundus with the notion of repeated rhinopharyngitis, and is in line with the literature which finds in the majority of cases similar symptomatology and rarely ophthalmoplegia and papilledema in cases of acute ethmoiditis in children. 4,6 A brain scan revealed acute ethmoiditis of the left maxillary sinus, complicated by right-predominant medial frontal cerebral empyema and a left superior-external intraorbital abscess (Chandler IV classification). The cerebral empyema observed in this case is consistent with data in the literature that supports the idea that children with upper orbital abscesses are more likely to have intracranial abscesses.…”

“…Inflammation with hyperleukocytosis remains an observation in several studies 6,13 . According to Chandler, most of the authors recommend empirical broad‐spectrum antibiotic therapy by the intravenous route, combining third generation cephalosporins or amoxicillin/clavulanic acid with quinolones, aminoglycosides, and imidazoles, depending on the stage of the disease 1,6,14,15 …”

“…6,13 According to Chandler, most of the authors recommend empirical broad-spectrum antibiotic therapy by the intravenous route, combining third generation cephalosporins or amoxicillin/clavulanic acid with quinolones, aminoglycosides, and imidazoles, depending on the stage of the disease. 1,6,14,15 While others recommend the combination of third generation cephalosporins and anti-staphylococci as they support the idea that children under 10 years of age are more likely to be infected with Streptococcus pneumoniae or Staphylococcus aureus and those over 10 years of age are more likely to be infected with polymicrobial pathogens. 3,13,16 In this case, antibiotic therapy with ceftriaxone, ciprofloxacin, gentamycin, metronidazole, and drainage of the intraorbital abscess were used.…”