Use of dexamethasone in septic cavernous sinus thrombosis coexisting with bacterial meningitis secondary to sinusitis: A case report

We present the case of a 69-year-old woman who developed septic cavernous sinus thrombosis (SCST) secondary to bacterial meningitis and sinusitis. She presented to the emergency department with frontal headache, neck stiffness, photophobia, exophthalmos, and fever. Initial investigations revealed extensive opacification of the paranasal sinuses on plain cranial computed tomography (CT), and blood tests indicated a bacterial infection. She initially received antibiotics and dexamethasone for suspected bacterial meningitis. Cerebrospinal fluid analysis revealed elevated glucose and protein levels as well as white and red blood cell counts, along with a negative Gram stain. An ophthalmology assessment and CT venography indicated a strong suspicion of cavernous sinus thrombosis, further confirmed by magnetic resonance venography. Anticoagulation with antibiotics and dexamethasone was initiated, leading to significant clinical improvement. This case highlights the importance of the early recognition and treatment of SCST and the role of dexamethasone in patients with coexisting bacterial meningitis.