Page 107 - ITPS-8-1

INNOSC Theranostics

and Pharmacological Sciences

CASE REPORT
Use of dexamethasone in septic cavernous sinus

thrombosis coexisting with bacterial meningitis
secondary to sinusitis: A case report

Wesam Albqa’een † , Nikesh K Giri † , Gemma Smith, and Revin Thomas*

Department of Stroke Medicine, University Hospital of North Durham, Durham, DH1 5TW, United Kingdom

Abstract

We present the case of a 69-year-old woman who developed septic cavernous sinus
thrombosis (SCST) secondary to bacterial meningitis and sinusitis. She presented
to the emergency department with frontal headache, neck stiffness, photophobia,
exophthalmos, and fever. Initial investigations revealed extensive opacification of
the paranasal sinuses on plain cranial computed tomography (CT), and blood tests
indicated a bacterial infection. She initially received antibiotics and dexamethasone
for suspected bacterial meningitis. Cerebrospinal fluid analysis revealed elevated
glucose and protein levels as well as white and red blood cell counts, along with a
† These authors contributed equally negative Gram stain. An ophthalmology assessment and CT venography indicated
to this work.
a strong suspicion of cavernous sinus thrombosis, further confirmed by magnetic
*Corresponding author: resonance venography. Anticoagulation with antibiotics and dexamethasone
Revin Thomas
(revin.thomas@nhs.net) was initiated, leading to significant clinical improvement. This case highlights
the importance of the early recognition and treatment of SCST and the role of
Citation: Albqa’een W, Giri NK,
Smith G, Thomas R. Use of dexamethasone in patients with coexisting bacterial meningitis.
dexamethasone in septic cavernous
sinus thrombosis coexisting with
bacterial meningitis secondary to Keywords: Septic cavernous sinus thrombosis; Dexamethasone; Corticosteroids;
sinusitis: A case report. INNOSC Bacterial meningitis; Sinusitis; Antibiotics; Anticoagulation
Theranostics and Pharmacological
Sciences. 2025;8(1):101-105.
doi: 10.36922/itps.4853
Received: September 14, 2024 1. Introduction
Revised: November 6, 2024
Cavernous sinus thrombosis (CST) is a rare yet serious condition that may complicate
Accepted: November 21, 2024 infections such as sinusitis, orbital cellulitis, and pharyngitis, particularly after a
Published online: December 6, thrombophilic event. It can present as septic or aseptic. The primary etiological
2024 organisms are bacteria, with Staphylococcus aureus accounting for approximately two-
Copyright: © 2024 Author(s). thirds of cases. Other frequently encountered pathogens include Streptococcus species. 1
This is an Open-Access article
distributed under the terms of the CST commonly arises from the hematogenous spread of infection to the cavernous
Creative Commons Attribution sinus through the venous system, particularly via sphenoid sinusitis. The pterygoid
License, permitting distribution, plexus, a valveless venous system that connects with the cavernous sinus, increases the
and reproduction in any medium,
provided the original work is susceptibility to impaired drainage. The fine, irregular structure of the cavernous sinus
properly cited. functions as a sieve, trapping bacteria and increasing the risk of thrombophlebitis. 2
Publisher’s Note: AccScience
Publishing remains neutral with 2. Case presentation
regard to jurisdictional claims in
published maps and institutional A 69-year-old Caucasian woman presented to the emergency department after a
affiliations. referral from her primary care physician, with a 3-day history of progressively severe

Volume 8 Issue 1 (2025) 101 doi: 10.36922/itps.4853