A case of orbital subperiosteal abscess caused by <i>Gemella haemolysans</i>

<p>Gemella haemolysans is a facultative anaerobic gram-positive coccus that resides in the oral cavity, pharynx, upper respiratory tract, gastrointestinal tract, and genitourinary tract of humans. G. haemolysans has a thin cell wall that can be decolorized in Gram staining, making it difficult to identify. We report a case of an orbital subperiosteal abscess caused by G. haemolysans. The patient was a 79-year-old woman with a history of extranasal sinus surgery. She was referred to our ophthalmology clinic by her ophthalmologist because she was having difficulty seeing, in addition to redness, swelling, and pain in her left cheek and eyelid, following a denture adjustment. She had decreased visual acuity and increased intraocular pressure. Based on a simple computed tomography (CT) scan of the face, nasal intraorbital complications were suspected leading to her visit to our department. A contrast CT scan of the sinus cavity revealed a postoperative maxillary cyst and abscess formation on the root of a tooth and in the subperiosteal space of the orbital wall. After puncture, incision, and drainage of the gingival region, intraocular pressure decreased and visual acuity improved. The patient was then admitted to the hospital and started on piperacillin/tazobactam. The following day, however, the eyelid swelling worsened and the intraocular pressure rose again, so the patient underwent endoscopic incision and drainage of the subperiosteal abscess and transnasal orbital decompression under general anesthesia. The eyelid swelling, decreased visual acuity, and elevated intraocular pressure improved promptly after the surgery, and the patient was discharged from the hospital on the fifth postoperative day. G. haemolysans was detected in an abscess specimen from the gingival region. This case highlights that nasal intraorbital complications refractory to conservative treatment require immediate surgical treatment.</p>