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Pain in the eye: a case of gonococcal orbital cellulitis

Orbital cellulitis (OC) causes inflammation of the ocular soft tissues posterior to the orbital septum. Untreated OC can cause serious complications including vision loss. Bacterial OC caused by Neisseria gonorrhoea is exceedingly rare. Here, we present the third reported case in the literature of postseptal gonococcal OC in adults. A 39yearold woman presented with progressive eye swelling, drainage and pain (figure 1). She denied any ocular trauma or recent sinusitis. A CT scan of the maxillofacial region was consistent with OC. The patient was initiated on intravenous ceftriaxone with marked improvement by hospital day 2. Wound culture taken from the patient’s eye grew N. gonorrhoea, and the urine nucleic acid amplification test was positive for N. gonorrhoea. On hospital day 3, the patient left against medical advice and was discharged with oral ciprofloxacin, which was modified to cefixime after returning to the hospital 1 day following discharge. Her gonococcal culture showed sensitivity to cefixime and ciprofloxacin. On followup, the patient noted compliance with her cefixime, stable vision and complete resolution of her orbital symptoms. OC is usually a result of sinusitis or trauma, but this patient’s OC was likely caused by selfinoculation, consistent with other case reports of gonococcal eye infections. Management of gonococcal OC is challenging given lack of guidelines and increasing gonococcal resistance to oral antibiotics. In order to effectively treat this serious disease, it is essential to test the isolate for resistance patterns. Sophie Miller, Tyler Degener, Pruthul Patel 3 Internal Medicine, LAC+USC Medical Center, Los Angeles, California, USA Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA Internal Medicine and Pediatrics, LAC+USC Medical Center, Los Angeles, California, USA