A 14-year-old boy presented to the emergency room with 5 days of fever and periorbital edema and erythema refractory to 4 days of augmentin and clindamycin. Examination revealed normal visual acuity, mild left periorbital edema and erythema, and a (-)1 supraduction deficit, concerning for orbital cellulitis. CT imaging revealed pansinusitis, orbital cellulitis with subtle orbital fat stranding, and a dilated superior ophthalmic vein with concern for thrombosis. This was confirmed on subsequent magnetic resonance venography. He was treated with intravenous antibiotics and enoxaparin with significant improvement in 24 hours. Standard hypercoagulable workup revealed positive lupus anticoagulant and cardiolipin of unclear significance; on genetic sequencing, he was found to have a homozygous mutation of the 4G variant of plasminogen activator inhibitor-1. Plasminogen activator inhibitor-1 homozygosity is a rare predisposing hypercoagulable state. This case highlights the importance of hematologic and genetic studies in adolescent patients with superior ophthalmic vein thrombosis, particularly those with mild presentation.

中文翻译：

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血栓前青少年患者脓毒性眼上静脉血栓形成。

一名 14 岁男孩因发烧 5 天、眶周水肿和红斑到急诊室就诊，4 天的安格汀和克林霉素治疗仍无效。检查显示视力正常，左侧眶周轻度水肿和红斑，以及 (-)1 上移缺陷，与眼眶蜂窝织炎有关。CT 成像显示全鼻窦炎、眼眶蜂窝组织炎并伴有细微的眼眶脂肪绞合，以及眼上静脉扩张（可能存在血栓）。随后的磁共振静脉造影证实了这一点。他接受静脉注射抗生素和依诺肝素治疗，24 小时内病情明显改善。标准高凝检查显示狼疮抗凝物和心磷脂呈阳性，但意义不明；基因测序发现，他患有纤溶酶原激活剂抑制剂-1 4G变体纯合突变。纤溶酶原激活剂抑制剂-1 纯合性是一种罕见的易诱发高凝状态。该病例强调了对患有眼上静脉血栓形成的青少年患者（尤其是症状轻微的患者）进行血液学和遗传学研究的重要性。