Aggressive Pasteurella multocida rhinosinusitis with orbital extension in a patient with liver cirrhosis: A case report and literature review

Pasteurella multocida often causes skin and soft tissue infections associated with animal bites and scratches. However, aggressive respiratory tract infections without animal exposure have been reported in immunocompromised hosts. We report the case of a Japanese woman in her early 80 s with liver cirrhosis that developed acute rhinosinusitis caused by P. multocida without animal-related wounds. She presented with swelling and redness of the left eyelid, and subsequently developed decreased vision and impaired eye movement. Imaging studies revealed an ethmoid sinus abscess with a bony defect of the medial orbital wall and extension into the orbit. Emergency drainage by endoscopic sinus surgery led to complete resolution of the decreased vision and impaired eye movement. A strain of P. multocida was identified from the purulent discharge. To the best of our knowledge, this is the first reported case of aggressive Pasteurella rhinosinusitis with orbital extension. It suggests that P. multocida can cause invasive rhinosinusitis in immunocompromised hosts such as those with liver cirrhosis, and it demonstrates a potential osteolytic effect upon the paranasal bony structure. • P. multocida can sometimes cause aggressive rhinosinusitis without animal exposure. • First proven osteolytic sinonasal P. multocida infection with orbital spread. • Early endoscopic surgical drainage achieved source control and preserved vision. • β-lactam antibiotics and surgery seem vital for invasive sinonasal pasteurellosis.