Bamboo-zled by “air” on CT: the fungal fiascoes of gardening
Author: Twishaa Sheth
Base Hospital / Institution: East Suffolk & North Essex NHS Trust
ePoster presentation
Abstract ID: 24-138
Purpose
Unusual case report highlighting diagnostic challenges & key learning points from an orbital trauma complicated by a rare fungal orbital cellulitis.
Methods
A healthy 71-year-old male presented with intense left eye pain & swelling after a fall whilst gardening, where a contaminated bamboo cane penetrated his left orbit. Exam showed VA of 6/15, left proptosis, ophthalmoplegia, lid swelling, RAPD, IOP of 53 mmHg & normal fundal exam.Lateral canthotomy & cantholysis had minimal effect; systemic acetazolamide & mannitol were administered. CT orbit indicated air in the left orbit around the superior & lateral recti, disrupting the left superior oblique (no orbital hemorrhage, optic nerve injury or fracture). IV antibiotics were initiated.
Results
Overnight, worsening proptosis was observed. A follow-up CT revealed presumed air space between the superior rectus & optic nerve, extending anteriorly, with gas pockets deep to the lateral rectus. Despite a seemingly negative CT, clinical suspicion persisted for intraorbital foreign body.Emergency orbit exploration, revealing pus & bamboo fragments, was performed via extended sub-brow incision. Fragments were sent for analysis & the wound was irrigated. Meropenem & amphotericin were added. Post-op MRI showed mild proptosis & small collections around the left globe. Microbiology: Scedosporium apiosermum complex sensitive to voriconazole (which was commenced); blood cultures reported no growth.One day post-op, pain improved, with a less tense orbit & reduced swelling. One week post-op, stability persisted: VA at 6/5, normal pupils & full color vision with referral to a strabismologist for diplopia trauma of left superior rectus & superior oblique.
Conclusion
This atypical case of severe fungal orbital cellulitis highlights key learning points: intraorbital bamboo fragments appear as radiolucent on CT & can mimic air; in this case, the fragments lay wedged between the superior rectus and optic nerve. High levels of clinical suspicion & low threshold for prompt orbital exploration are required to restore vision, especially if the radiolucencies are linear.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Zhi | Lin | East Suffolk & North Essex NHS Trust |
