Orbital cellulitis revealing a brain abscess

Abstract

A 20-year-old man with headaches and swelling of the right upper eyelid, gradually increasing in size over the previous 10 days, presented at the Military Hospital Moulay Ismail of Meknes, Morocco, for evaluation. On examination, there was erythema and edema of the right upper eyelid (A). Orbital-cerebral computed tomography revealed an associated orbital abscess extending to the upper eyelid, pansinusitis, and a frontal cerebral abscess (B, arrows). The patient was initiated on parenteral antibiotics (third-generation cephalosporin, metronidazole, aminoglycoside) combined with analgesics and corticosteroids and underwent evacuation puncture of the palpebral abscess, evacuation of the frontal abscess with trepanation, along with ethmoidectomy, middle meatotomy, and drainage of the right frontal and maxillary sinuses. He improved after 1 month, with total resolution of the abscesses by 3 months (C-D). Orbital cellulitis is a common cause of acute inflammation of the orbit, often secondary to infectious periocular invasion, especially of sinus origin. Untreated, blindness or even death may result. This case highlights the value of early diagnosis and urgent treatment.