Periorbital Cellulitis With Sinusitis

A 68-year-old woman was admitted to the hospital with rapidly increasing, painful swelling of the left eye. She had moderately severe, corticosteroid-dependent chronic obstructive pulmonary disease.

Clinical examination revealed a cachetic, febrile woman with tachycardia and tachypnea. Considerable left periorbital cellulitis was noted (A), but there was no pain with eye movements. Diffuse rhonchi were detected in both lungs.

The complete blood cell count was 22,000/µl, with 90% polymorphonuclear cells. The erythrocyte sedimentation rate was 62 mm/h. A CT scan of the sinuses confirmed left maxillary and frontal sinusitis.

Intravenous ampicillin with sulbactam and intravenous corticosteroids were given along with aggressive bronchodilator therapy. The left maxillary sinus was drained on an emergent basis. After 1 week of treatment, the swelling and pain of the patient’s left eye subsided (B).