Orbital cellulitis in a child with sickle cell anemia

Purpose Orbital cellulitis and preseptal cellulitis are the major infections of the ocular adnexal and orbital tissues. Orbital cellulitis is an infection of the soft tissues of the orbit, posterior to the orbital septum.The purpose of this text is to point out sickle-cell disease as an important risk factor in a 2-year-old boy with sinusitis. Methods We evaluated a 2-year-old boy with sickle-cell disease and sinusitis treated with oral amoxicillin (80 mg/kg/day). He presented a remarkable proptosis, intense ophthalmoplegia and conjunctival chemosis, with a temperature of 39°C and leukocytosis with left shift. We treated him with clindamycin 30 mg/kg, cefotaxime 200 mg/kg and prednisolone IV. Results Axial image CT scan demonstrated sinusitis of the left ethmoid sinus. Furthermore, there was a left sided subperiosteal abscess between the medial wall of the left orbit and the left medial rectus muscle. Due to the bad evolution and the CT scan image, the sinus was drainage in a surgical procedure under general anesthesia. Appropriate patient evolution was achieved without the need for additional therapy. Conclusions Patients with sickle-cell anemia show anincreased risk of severe bacterial infections due to loss of functioning spleen tissue. Daily penicillin prophylaxis is the most commonly used treatment during childhood. Orbital cellulitis can result in orbital and intracranial complications. Blindness may occur secondary to elevated intraorbital pressure. This is the reason we must control the patient at least daily and evaluate the antibiogram. Finally, when medical treatment is not working and there is an elevated intraorbital pressure with involvement of the eyeball, the surgery cannot be postponed.