Evaluation of Pediatric Preseptal Cellulitis Cases Diagnosed with Meningitis by Magnetic Resonance Imaging

Rhinosinusitis is a common infection and may rarely cause severe life-threatening orbital and intracranial complications. In this study, two cases with preseptal cellulitis and meningitis as a complication of rhinosinusitis were presented in the light of the literature. A nine years and two months old girl was admitted with complaints as fever, redness and swelling in the left eye. Physical examination revealed erythema and edema in the left lower and upper eyelids, and the eye movements were painless and normal in all directions. Her systemic examination was normal and there was no sign of meningeal irritation. Magnetic resonance imaging revealed ethmoid, frontal and sphenoid sinusitis and left cerebral hemisphere dural meningeal contrast enhancement. The patient was diagnosed with meningitis after lumbar puncture. After 14 days of appropriate antibiotic treatment, the patient recovered and was discharged. An eight years and five months old boy presented with fever, redness and swelling in the left eye was admitted. There were erythema and edema in the left lower and upper eyelid; the eye movements were painless in all directions and were complete. Systemic examination was normal; there was no sign of meningeal irritation. Pansinusitis and preseptal cellulitis findings were detected on computer tomography. The patient's fever persisted under treatment and erythema and edema of the eye became more evident. Orbital MRI was performed considering the complication and contrast enhancement was observed in the left frontal region. The patient was diagnosed with meningitis after lumbar puncture. After 14 days of appropriate antibiotic treatment, the patient recovered and was discharged. Intracranial complication due to preseptal sinusitis is rare but life-threatening. In these cases, we recommend the use of MRI as the radiological imaging method.

Magnetik rezonans inceleme sayesinde menenjit tanýsý konulan preseptal sellülit tanýlý pediatrik olgularýn deðerlendirilmesi

Rinosinüzit, yaygýn bir enfeksiyon olup nadiren hayatý tehdit eden orbital ve intrakranial ciddi komplikasyonlara yol açabilir. Çalýþmamýzda rinosinüzit komplikasyonu olarak preseptal sellülit ve menenjit birlikteliði geliþen iki olgu literatür verileri eþliðinde sunulmuþtur.
Olgu 1: 9 yaþ 2 aylýk kýz çocuk; ateþ, sol gözde kýzarýklýk ve þiþlik þikayetiyle getirildi. Fizik muayenede sol alt ve üst göz kapaðýnda ileri derece eritem, ödem mevcuttu, göz hareketleri her yöne aðrýsýz ve normaldi. Sistem muayeneleri normal, meningeal iritasyon bulgusu yoktu. Manyetik rezonans (MR) görüntüleme sonucunda preseptal sellülit, etmoid, frontal ve sfenoid sinüzleri içeren rinosinüzit, sol serebral hemisferde dural meningeal kontrast tutulumu saptandý. Hastaya lomber ponksiyon iþlemi sonucunda menenjit tanýsý konuldu. Hasta 14 gün uygun antibiyotik tedavisi sonrasýnda iyileþerek taburcu edildi.
Olgu 2: 8 yaþ 5 aylýk erkek çocuk; ateþ, sol gözde kýzarýklýk ve þiþlik þikayetiyle getirildi. Sol alt ve üst göz kapaðýnda eritem ve ödem mevcuttu. Sistem muayeneleri normal, meningial iritasyon bulgusu yoktu. Bilgisayarlý sinüs tomografisinde pansinüzit ve preseptal sellülit bulgularý saptandý. Tedavi altýnda ateþi devam eden, gözdeki eritem ve ödemi belirginleþen hastaya komplikasyon düþünülerek yapýlan orbital MR görüntülemede sol frontal bölgede kontrast tutulumu izlendi. Lomber ponksiyon iþlemi sonucunda hastaya menenjit tanýsý kondu. Hasta 14 gün uygun antibiyotik tedavisi sonrasýnda iyileþerek taburcu edildi.
Sonuç: Preseptal sinüzite baðlý olarak intrakranial komplikasyon nadir olarak görülmekte ancak hayatý tehdit edebilmektedir. Bu durumlarda radyolojik görütüleme yöntemi olarak MR tercih edilmesini önermekteyiz. (SETB-2019-06-092)