Abstract

A 5-year-old savannah monitor (Varanus exanthematicus) was presented for left-sided facial swelling. Examination revealed left hemi-maxilla and eyelid swelling causing caudoventral displacement of the left eye. Computed tomography (CT) of the head was conducted prior to surgical exploration, debridement, and culture of the swelling. CT images revealed a mass extending from the left retrobulbar area to the temporal muscle with extensive lysis of the epiterygoid bone resulting in compression of the brainstem. Surgical exploration allowed for partial debridement of the mass and sample collection for bacterial culture. Salmonella enterica Kintambo was isolated from the swelling and was sensitive to several antibiotics. Ceftazidime (40 mg/kg) and piperacillin (100 mg/kg) mixed with poloxamer 407 gel was subsequently injected into the swelling. Oral enrofloxacin (10 mg/kg q24h weaned to 5 mg/kg q24h) was prescribed and continued for 5 months prior to discontinuation. Over the following 5 months, external facial swelling resolved, but oral swelling persisted. Swelling of the eyelids also resolved, and it was suspected by the owner that the savannah monitor was no longer visual from that eye. Over the next 2 years, the oral swelling also completely resolved, but vision was not regained for the left eye. This case documents the resolution of a deep facial osteomyelitis lesion documented by CT images highlighting brain compression from an extracranial soft tissue mass on the squamate lateral cartilaginous braincase with resolution following local antibiotic instillation in a reptile without aggressive debridement.