Septic cavernous sinus thrombosis with diffuse spread leading to cerebral ischemia.

Introduction: Septic cavernous sinus thrombosis (CST) is a rare disease with many etiologies and a diffuse array of initial presentation leading to high mortality.

Case: A 25-year-old male with a history of a nasal furuncle presents with an acute onset of fixed and dilated pupils, bilateral exophthalmos, hemorrhagic chemosis, elevated intraocular pressures, restricted extraocular motility, and unresponsiveness. A retinal septic emboli in the left eye is present on dilated fundoscopic exam while an exudative retinal detachment is present in the right eye. MRI/MRV revealed extensive thrombosis of cavernous sinuses, distal sigmoid dural sinuses, and proximal internal jugular veins with associated cerebral edema and multifocal areas of venous infarction. Blood cultures grew Methicillin-resistant Staphylococcus aureus and the patient suffered multi-system organ failure. Despite treatment with full dose systemic anticoagulation and broad spectrum antibiotics the patient suffered a cardiopulmonary arrest and expired.

Comment: The acuity of onset coupled with the multiple risk factors for septic cavernous sinus thrombosis in this patient led to a fulminant presentation of this disease and ultimate poor outcome.