Case Presentation
The patient is a 76-year-old white male who tested positive for COVID-19 but was sent from a nursing facility for left eye drainage and ”psychiatric evaluation.” Upon presentation, the patient was not fully oriented and could not provide a history of the eye drainage. His past medical history is significant for hypertension, Type 2 diabetes mellitus requiring insulin, diabetic ketoacidosis, testicular cancer, and transient ischemic attack. CT scan upon presentation showed sinusitis with left orbital and periorbital abscess formation, cellulitis, and extensive osteomyelitis (Figures 1-3). The margin of the orbital abscess was within the inferior margin of the globe, where there appeared to be an open defect within the globe itself. The patient also had a chest x-ray showing some patchy infiltrates, particularly in the right lung, consistent with a COVID-19 infection.
The patient was admitted and subsequently underwent endoscopic left middle turbinate reduction, endoscopic left maxillary antrostomy with tissue removal, and endoscopic anterior ethmoidectomy with the Otolaryngology service the following day. The patient also underwent left orbiotomy with drainage of the left orbital abscess with the Opthalmology service that same day. During surgery, his nasal cavity was oddly avascular (Figure 4). The turbinate was edematous but pale. The mucosa did not bleed when manipulated. When the bone of the middle turbinate and medial wall of the maxilla were removed with Tru cut forceps, they did not bleed. The fat of the orbit was pale. Cultures were taken during surgery and returned positive for MRSA, Streptococcus constellatus, and Peptoniphilus indolicus. He completed several days of intravenous antibiotics during the hospitalization but continued to have drainage from his left eye (Figures 5-6). Otolaryngology evaluated him daily and had no plans to do further surgery. He was deemed hemodynamically and neurologically stable and was transferred back to his nursing facility for completion of intravenous antibiotics.