Intracranial and facial involvement in complicated rhinosinusitis: a case report

Abstract

Objective: To report the case of a patient who developed bilateral orbital cellulitis, meningitis and sigmoid sinus thrombosis secondary to rhinosinusitis, scientifically reviewing each diagnosis and their interrelationships. Case details: Male patient, 16 years old, illicit drug user, starts symptoms of headache, delirium, bilateral eyelid edema, eye pain, blurred vision and fever after an upper airway infection. Laboratory tests showing leukocytosis and cerebrospinal fluid indicative of bacterial meningitis. A broad-spectrum antibiotic therapy was started, and also a neurosurgical drainage of a subdural empyema in a posterior fossa. An ophthalmological procedure of an extraocular intraorbital collection of soft tissues on the right were done. Sigmoid sinus thrombosis treated clinically with anticoagulation. Final considerations: Rhinosinusitis is viral and self-limiting most of the time, but in about 0.5 to 2%, secondary bacterial infection can occur, which can evolve with severe intracranial and facial complications if the diagnosis is not closed and adequate treatment instituted quickly. In possible complications, treatments are expensive and prolong hospital stay, in addition to the high risk of permanent sequelae.