Double trouble: preseptal cellulitis due to two species with multidrug resistance
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A 2 Year old boy presented with painful ballooning of both eyes with the 2 days history of trauma to the head while playing. His vaccination was complete. On examination he was afebrile. The Eyes were ballooned with blackish crust over both lids. On local examination, eye swelling was tense with severe tenderness. The diagnosis of Preseptal cellulitis was made .We did an Emergency drainage and pus was sent for culture that came out to be positive for Pseudomonas aeruginosa and Proteus mirabilis with multiple drug resistance. The coverage was given by Imipenem + cilastatin and child had wonderful recovery.
KeywordsSinusitis Imipenem Cellulitis Proteus Mirabilis Multiple Drug Resistance
Letter to the Editor
Imipenem & Cilastatin
Preseptal cellulitis is characterized by hyperemic skin and eyelid distension without the obvious signs of orbital congestion . Preseptal cellulitis can occur as a result of exogenous as well as endogenous extension . In this particular case the rare combine infection by two bacteria with multi drug resistance made this case interesting and difficult to manage. This infection can progress to involve the post-septal space and result in orbital cellulitis with life threatening complications. Majority of the cases are caused by Streptococci or Staphylococci . While making diagnosis, this condition should be differentiated from other causes of Eye swelling ranging from simple inflammation to life threatening Retinoblastoma . Once this diagnosis is suspected it should be related with lab investigations like complete blood count, blood culture and culture of aspirate so that therapy should be targeted . Computed Tomography is recommended investigation to delineate the extension of the cellulitis ; however, is not necessary. Nasal decongestants are recommended if sinusitis is suspected and antibiotics should be continued from three to ten days depending on severity of the infection.
Vision is the most wonderful sense gifted by nature and restoration of vision after such sinister infection was the source of joy both for family and doctors.
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