A Rare Case of Maxillary Sinus Osteomyelitis with Intraorbital, Extraconal Abscess in a Term Low Birth Weight Twin

Janampally Ravikiran ； Swathi Chacham ； Uppin Narayan Reddy ； Jillalla Narsing Rao ； Ekta Aggarwal ； Anumula Soumya ； Nori Madhavi

《International Journal of Case Reports and Images (IJCRI)》 6卷3期 (2015/03) Pp. 132-137

https://doi.org/10.5348/ijcri-201524-CR-10485

並列摘要

Introduction: Acute osteomyelitis in neonates is a rare infectious disorder of bone leading to diagnostic and therapeutic challenge, more so in neonates. While the long bones are frequently affected sites, maxilla is rarely involved. Physiological immaturity of the immune system coupled with invasive diagnostic and therapeutic procedures render them susceptible for this condition, more so in premature, low birth weight infants. The most common organism causing osteomyelitis in neonates is Staphylococcus aureus. Lesion of the orbit as well as contiguous faciomaxillary and sinonasal inflammatory pathology often lead to proptosis in neonates. Case Report: We report a 15-day-old term female neonate (twin 1) presenting with non-traumatic periorbital swelling and purulent nasal discharge. The neonate also had failure to thrive. On clinical examination, the neonate was sick with sclerema and shock. There was right eye proptosis with edema and erythema. Initial diagnosis of periorbital abscess or orbital tumor was considered and the infant was investigated. Sepsis screen was positive with marked polymorphic leukocytosis. Also, the blood culture and culture from sinus scraping grew Staphylococcus aureus. Magnetic resonance imaging scan of the brain including orbit revealed osteomyelitis of maxilla and intraorbital extraconal mass with restricted diffusion, suggesting intraorbital abscess. The neonate responded to intravenous antimicrobials and decompression of the abscess. Although, the source of this major infection is unidentified, low birth weight, failure to thrive and poor socioeconomic status might have contributed. Conclusion: We report a term, low birth weight, female neonate with culture positive sepsis, maxillary sinus osteomyelitis and orbital abscess. Osteomyelitis of the maxilla is a rare entity and an important etiological factor for orbital abscess.

並列關鍵字

Maxillary sinus ； Neonate ； Orbital abscess ； Osteomyelitis ； Proptosis