Acute on Chronic Rhinosinusitis Complicated with Orbital Subperiosteal Abscess in Previously Operated and Immunocompromised Adult-Case Report

慢性鼻及鼻竇炎急性發作併發眼眶骨膜下膿瘍於曾接受過手術及免疫功能低下之成人－病例報告

陳佳郡(Chia-Chun Chen) ； 王俞鈞(Yu-Chun Wang)

《台灣耳鼻喉頭頸外科雜誌》 57卷1期 (2022/03) Pp. 58-62

https://doi.org/10.6286/jtohns.202203_57(1).058

摘要

Orbital complications related to rhinosinusitis are rare in adults, with a prevalence of 1.7%, and are rarely discussed in the literatures. We report on a 64-year-old woman who is immunocompromised, with a history of bilateral Caldwell-Luc surgery. She had a subperiosteal abscess complicated by acute on chronic rhinosinusitis. She received both intravenous antibiotic therapy and right endoscopic sinus surgery. The subperiosteal abscess was drained through the right lamina papyracea dehiscence, and a fungal ball in the right sphenoid sinus was identified and removed during surgery. The symptoms were completely resolved with no complications or recurrence for 6 months postoperatively. Because of the rarity of this condition and the importance of its clinical management, we present this case to highlight the key characteristics and treatments of rhinosinusitis with orbital complications in the adult population.

關鍵字

immunocompromised ； orbital complications ； previously operated ； rhinosinusitis ； subperiosteal abscess

並列摘要

鼻竇炎合併眼部併發症在成人中相對少見，盛行率約1.7%，回顧過往文獻也較少提及成人案例。此病例報告為1名於40年前曾接受雙側Caldwell-Luc手術之64歲免疫功能低下女性，患有慢性鼻竇炎合併眼眶骨壁的骨膜下膿瘍（subperiosteal abscess）。病患接受針劑型抗生素治療及右側鼻竇內視鏡手術，術中經右側紙狀板缺損處（lamina papyracea dehiscence）引流眼眶骨壁的骨膜下膿瘍，並將右側蝶竇內之黴菌球（fungal ball）移除。術後病患復原良好，於6個月內並無顯著復發。由於慢性鼻竇炎合併眼部併發症在成人較少見但病程惡化進展快速，故特提出此病例報告並回顧相關文獻，以期強調在臨床判斷此類疾病嚴重度及治療方式之重要性。

並列關鍵字

immunocompromised ； orbital complications ； previously operated ； rhinosinusitis ； subperiosteal abscess（免疫功能低下 ； 眼眶併發症 ； 曾接受手術 ； 鼻及鼻竇炎 ； 骨膜下膿瘍）