Complex

A 12-year-old girl presents with redness, swelling, and protrusion of her left eye since waking up a couple of hours ago. There is no alteration in the vision of the affected eye.

Her history is significant for left-sided central facial pain for one day, and a frontal headache and rhinorrhea for two days. Her mother put these symptoms down to a case of 'sinus infection' and did not seek medical attention.

There is no history of facial trauma or insect bites to the affected area. Her medical, surgical, drug, allergic, and family histories are all unremarkable.

Select Relevant Investigations
Complete blood count

Performed

WBC: 13,500/mm3 (4,100-8,900)
N: 9,500/mm3 (1,800-8,000)
L: 2,100/mm3 (1,200-5,700)
Hb: 13.2 g/dL (12.0-14.0)
Plt: 300,000/mm3 (150,000-400,000)
Contrast CT Orbits + Brain

Performed

The CT scan reveals a small left-medial subperiosteal abscess and left ethmoid sinusitis. No other abnormalities are noted.
Blood cultures

Performed

Culture results will be available in 48 to 72 hours.
Lumbar puncture

Performed

The CSF analysis shows no abnormalities. Culture results will be available in 48 to 72 hours.

Select Relevant Management
ICU admission
IV antibiotics
Nasal decongestants
Surgical drainage