Seizure Secondary to Orbital Cellulitis

Purpose: We report a unique case of pediatric patient who developed seizure secondary to orbital cellulites with negative brain imaging study. Methods: A 7-year-old girl was referred to our clinic for the evaluation of painful left periorbital swelling and redness. On the initial orbital computed tomography (CT), there was a severe inflammation of subcutaneous tissue of the left orbit and the inflammation was spread to the medial orbital wall. Left maxillary and ethmoidal sinusitis were also noted. Results: Under the impression of orbital cellulitis secondary to sinusitis, broad-spectrum systemic antibiotics were administrated. In spite of antibiotics treatment, a generalized tonic seizure developed three days after initiation of antibiotics. CSF analysis showed the typical picture of bacterial meningitis. 3rd generation cephalosporin was added to the antibiotics regimen and the patient showed a complete recovery after 2 weeks without any sequel. Conclusions: Intracranial infection should not be ruled out despite a negative brain imaging studies. 3rd generation cephalosporin, known to have a good permeability of the blood-brain barrier, should be recommended in treating the intracranial complications developed secondary to orbital cellulites.