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Case Report
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| A rare case of maxillary sinus osteomyelitis with intraorbital, extraconal abscess in a term low birth weight twin | ||||||
| Janampally Ravikiran1, Swathi Chacham2, Uppin Narayan Reddy3, Jillalla Narsing Rao4, Ekta Aggarwal5, Anumula Soumya1, Nori Madhavi6 | ||||||
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1MBBS, (MD, Pediatrics), Junior Resident, Department of Pediatrics, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India.
2MD Pediatrics, DM Neonatology (PGIMER, Chandigarh), Associate Professor, Department of Pediatrics, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India. 3MD Pediatrics, Professor and Head, Department of Pediatrics, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India. 4MD Pediatrics, Professor, Department of Pediatrics, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India. 5MS Ophthalmology, Department of Ophthalmology, Vason Eye Hospital, Hyderabad, Telangana, India. 6MD Radiology, Associate Professor, Department of Radiology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India. | ||||||
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| Ravikiran J, Chacham S, Reddy UN, Rao JN, Aggarwal E, Soumya A, Madhavi N. A rare case of maxillary sinus osteomyelitis with intraorbital, extraconal abscess in a term low birth weight twin. Int J Case Rep Images 2015;6(3):132–137. |
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Abstract
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Introduction:
Acute osteomyelitis in neonates is a rare infectious disorder of bone leading to diagnostic and therapeutic challenge, more so in neonates. While the long bones are frequently affected sites, maxilla is rarely involved. Physiological immaturity of the immune system coupled with invasive diagnostic and therapeutic procedures render them susceptible for this condition, more so in premature, low birth weight infants. The most common organism causing osteomyelitis in neonates is Staphylococcus aureus. Lesion of the orbit as well as contiguous faciomaxillary and sinonasal inflammatory pathology often lead to proptosis in neonates.
Case Report: We report a 15-day-old term female neonate (twin 1) presenting with non-traumatic periorbital swelling and purulent nasal discharge. The neonate also had failure to thrive. On clinical examination, the neonate was sick with sclerema and shock. There was right eye proptosis with edema and erythema. Initial diagnosis of periorbital abscess or orbital tumor was considered and the infant was investigated. Sepsis screen was positive with marked polymorphic leukocytosis. Also, the blood culture and culture from sinus scraping grew Staphylococcus aureus. Magnetic resonance imaging scan of the brain including orbit revealed osteomyelitis of maxilla and intraorbital extraconal mass with restricted diffusion, suggesting intraorbital abscess. The neonate responded to intravenous antimicrobials and decompression of the abscess. Although, the source of this major infection is unidentified, low birth weight, failure to thrive and poor socioeconomic status might have contributed. Conclusion: We report a term, low birth weight, female neonate with culture positive sepsis, maxillary sinus osteomyelitis and orbital abscess. Osteomyelitis of the maxilla is a rare entity and an important etiological factor for orbital abscess. | |
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Keywords:
Maxillary sinus, Neonate, Orbital abscess, Osteomyelitis, Proptosis
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Author Contributions
Janampally Ravikiran – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Swathi Chacham – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Uppin Narayan Reddy – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Jillalla Narsing Rao – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Ekta Aggarwal – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Anumula Soumya – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Nori Madhavi – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Janampally Ravikiran et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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