Unique presentation of cavernous sinus thrombosis in a paediatric patient

A paediatric patient presented with periorbital oedema and fever. Initially, there was low suspicion for cavernous sinus thrombosis and orbital cellulitis due to the presence of full extraocular movements. However, given worsening bilateral periorbital oedema, lethargy and sepsis, neuroimaging was performed demonstrating inflammation and enhancement of the leptomeninges and left cavernous sinus, and raising concern for cavernous sinus thrombosis in the setting of orbital cellulitis. Prior to imaging, the patient’s periorbital oedema was attributed to preseptal cellulitis. However, the lack of response to oral antibiotics and worsening symptoms, combined with imaging results, aided in confirming suspicion of cavernous sinus thrombosis. The patient received intravenous antibiotics and anticoagulation. At 3-month follow-up, there was a complete resolution of orbital findings. This patient’s case demonstrates an atypical presentation of orbital cellulitis and the utility of early imaging to aid in the timely diagnosis and management of cavernous sinus thrombosis in young patients.