Recurring orbital complications of acute rhinosinusitis

A 53 year old patient presented herself suffering from therapy-refractory sinusitis since 8 weeks with swelling and reddening of the left eye. She further reported a history of psoriatic arthritis, currently under treatment with MTX and Secukinumab. The endoscopic examination revealed pus in the middle meatus. The CT-scan revealed opacification of all sinuses on the left side compatible with unilateral pansinusitis with additional subperiostal abscess of the orbit. The initial surgery combined endoscopic sinus surgery including the removal of lamina papyracea with a lateral canthotomy in order to decompress the orbit.

Under antibiotic treatment the patient recovered and was discharged on the 7th day post-surgery. More than 2 weeks later the patient presented herself again with substantial swelling of the left eye. Radiologic examination revealed multiple intraorbital abscess for which repeated surgeries were necessary. After pausing and wash-out of Secukinumab no further orbital complications occurred.

Discussion:

suppression of IL-17A with Secukinumab may have contributed to this treatment refractory disease. IL-17 A plays an essential role in T-cell based immune mechanisms and infection control. This case is a showcase for potential mechanisitic side effects of targeted biological therapy.

Publication History

Publication Date:
12 June 2019 (online)