Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient

We described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.The case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.Group A beta-haemolitic streptococcus (GAS) being the most common etiology of sore throats caused by bacteria. It has been estimated that GAS is responsible for around 15-30% of cases of acute pharyngitis in children [1]. Streptococcal pharyngitis is most common in children 5 to 12 and presents with a predominant sore throat and a temperature higher than 38.5°C. Symptoms include fever, chills, myalgias, headaches and nausea. Physical findings may include pharyngeal and tonsillar erithema and exudates and cervical adenopathy [2]. Sequelae associated to the GAS infection include non-suppurative (or post-streptococcal) complications as rheumatic fever and glomerulonephritis and suppurative complications as cervical lymphadenitis, peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, thrombosis of the intracranial venous sinuses, endocarditis, pneumonia, sepsis. In rare cases, nec