{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:38:44Z","timestamp":1759538324467,"version":"build-2065373602"},"reference-count":11,"publisher":"SMC Media","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Orbital apex syndrome (OAS) is a vision-threatening condition characterized by optic neuropathy, ophthalmoplegia, and cranial nerve dysfunction at the orbital apex. While fungal and neoplastic aetiologies are well recognized, bacterial causes are uncommon.\u00a0Serratia marcescens, an opportunistic Gram-negative bacillus primarily associated with nosocomial infections, has rarely been implicated in sinusitis or orbital apex involvement. Case report:\u00a0A 73-year-old woman with type 2 diabetes presented with progressive unilateral headache, diplopia, and vision loss. She was empirically treated for allergic and bacterial sinusitis, including steroids, without improvement. Imaging showed left sphenoethmoid sinus opacification with orbital apex involvement, and initial endoscopy suggested fungal sinusitis. Repeat biopsy ruled out fungal disease and malignancy, while cultures identified\u00a0S. marcescens\u00a0susceptible to cephalosporins and fluoroquinolones. Antifungals were discontinued and completed levofloxacin with rapid clinical recovery. At 2-month follow-up, imaging confirmed resolution of orbital apex inflammation and sinus disease. Conclusion:\u00a0This case highlights\u00a0S. marcescens\u00a0as a rare cause of OAS in the setting of sphenoid sinusitis. Awareness of atypical bacterial pathogens, avoidance of premature steroid or antifungal therapy, and reliance on repeat endoscopy with cultures are critical for timely diagnosis and vision preservation.<\/jats:p>","DOI":"10.12890\/2025_005814","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T12:34:28Z","timestamp":1758890068000},"source":"Crossref","is-referenced-by-count":0,"title":["Serratia marcescens sinusitis presenting as left orbital apex syndrome"],"prefix":"10.12890","volume":"12","author":[{"given":"Yusuf","family":"Kagzi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Illinois College of Medicine, Peoria, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murtaza","family":"Khambati","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Illinois College of Medicine, Peoria, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varshini","family":"Thiruvadi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Illinois College of Medicine, Peoria, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tulika","family":"Chatterjee","sequence":"first","affiliation":[{"name":"Edward Via College of Osteopathic Medicine Louisiana Campus, Monroe, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Badakere A, Patil-Chhablani P. 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Serratia marcescens endophthalmitis associated with intravitreal injections of bevacizumab. Eye (Lond) 2010;24:226-232. doi: 10.1038\/eye.2009.86","key":"10.12890\/2025_005814_ref7","DOI":"10.1038\/eye.2009.86"},{"doi-asserted-by":"crossref","unstructured":"Peeters A, Vandercam B, Sindic CJ, Hantson P, Mahieu P. Community-acquired Serratia marcescens meningitis. J Infect 1997;35:303-304. doi: 10.1016\/s0163-4453(97)93384-3","key":"10.12890\/2025_005814_ref8","DOI":"10.1016\/S0163-4453(97)93384-3"},{"doi-asserted-by":"crossref","unstructured":"Richter AL, Gallagher KK. Chronic invasive fungal sinusitis causing a pathologic Le Fort I fracture in an immunocompetent patient. Ear Nose Throat J 2016;95:E1-3. doi: 10.1177\/014556131609500904","key":"10.12890\/2025_005814_ref9","DOI":"10.1177\/014556131609500904"},{"doi-asserted-by":"crossref","unstructured":"Breazzano MP, Jonna G, Nathan NR, Nickols HH, Agarwal A. Endogenous Serratia marcescens panophthalmitis: A case series. 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