Cavernous Sinus Thrombosis in a Teenager with Posterior Scleritis
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Yes
Purpose
We aim to report the case of a teenager with posterior scleritis, who developed cavernous sinus thrombosis (CST) in the setting of inflammatory bowel disease (IBD).
Methods
Descriptive case report.
Results
A 17-year-old male presented with bilateral eye redness, pain and painful ocular movements. Best corrected visual acuity (BCVA) was 6/6 in each eye. Bilateral optic disc (OD) swelling was noted and echography demonstrated posterior scleral thickening and positive T-sign. Prednisone was instituted with marked improvement. Four months later, he presented with headache, left eye pain and redness. He also suffered from recurrent oral ulcers, abdominal pain and diarrhea. There were signs of active left anterior scleritis and worsening of OD swelling bilaterally. Prednisone dose was increased, however, he continued to complain of headache. Brain MRI revealed the presence of a filling defect in the left cavernous sinus, consistent with cavernous sinus thrombosis. Hypercoagulability panel showed an elevated Factor VIII level of 245 IU/dL (normal <150 IU/dL). A genetic thrombophilia screen revealed a heterozygous mutation in the prothrombin gene (G20210A). Fecal calprotectin level was elevated at 378 μg/g (normal <50 μg/g), suggesting active IBD. Anticoagulation was instituted. Prednisone was continued and azathioprine was added. The patient completed one-year of follow-up, during which there was no recurrence of headache, OD swelling, scleritis or gastrointestinal symptoms.
Conclusion
This patient’s presentation with CST in the setting of IBD-related posterior scleritis is rare and highlights how systemic inflammatory diseases can predispose patients to a hypercoagulable state, manifesting as potentially serious vascular complications.
Conflict of interest
No
1
Last name
ABU AL-HALAWA
Initials of first name(s)
D
Department
Ophthalmology
City
Jerusalem
Country
Israel
2
Last name
ABDEL JALIL
Initials of first name(s)
S
Department
Ophthalmology
City
Jerusalem
Country
Israel
3
Last name
AMER
Initials of first name(s)
R
Department
Ophthalmology
City
Jerusalem
Country
Israel
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