PMC10465287_01
The patient's face on arrival. The right side of the face showed redness and swelling.
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Her face had redness, swelling and pain (Fig. 1) in addition to pain at the left side of the thorax and back.
Time course of treatment and main laboratory results. The antibiotics therapy was switched without antifungal drugs. However, her condition ultimately deteriorated. Steroid pulse, 1 g of methylprednisolone per day for 3 days. Prednisolone, 50 mg per day.
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The time course of treatment and the main laboratory findings are shown in Fig. 2. Antibiotics and steroid infusion were changed (cefazolin to vancomycin on day 3) because her symptoms deteriorated (Fig. 2), with severe eye pain and exophthalmos.
Facial magnetic resonance imaging (MRI) findings on day 6. MRI showed right orbital cellulitis with deformity of the right eyeball due to swelling of the musculus orbicularis oculi (left, short inversion time inversion recovery image; right, T1-weighed image).
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Facial magnetic resonance imaging (MRI) on day 6 showed orbital cellulitis with deformity of right eye ball due to swelling of musculus orbicularis oculi (Fig. 3).
Facial magnetic resonance imaging (MRI) findings on day 12. MRI of the face and brain revealed acute inflammatory or ischemic signal changes at the bilateral frontal lobes (triangle, diffusion-weighted imaging) and abnormal signal changes in the cerebrospinal fluid at the frontal side (*).
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However, on day 12, her left visual acuity decreased, and emergency MRI of the face and brain revealed acute inflammatory or ischemic signal changes at the bilateral frontal lobes, abnormal signal changes in the cerebrospinal fluid (CSF) at the frontal side (Fig. 4), and persistent right exophthalmos.