Acute isolated sphenoid sinusitis in a 4-year-old child: a rare case with an atypical presentation

Aikaterini Monti ,Constantine Katsanoulas ,Maria Farini

doi:10.22514/sv31.042008.8

Aikaterini Monti , Constantine Katsanoulas + Show 1 more

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https://doi.org/10.22514/sv31.042008.8

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Journal: Signa Vitae	Publication Date: Jan 1, 2008
Citations: 2	License type: cc-by

Affiliation: Ippokrateio General Hospital of Thessaloniki

Abstract

Acute, isolated, sphenoid sinusitis is unusual, especially in children. Its incidence is about 2.7% of all sinus infections and is even rarer in children under the age of six years. It is frequently misdiagnosed because of its atypical presentation and it can cause serious complications because of the sphenoid sinus' anatomical relations with many intracranial structures. We report a case of a previously healthy 4 year old boy, whose sole symptom at presentation was drowsiness. Physical examination and initial laboratory investigations were normal. Diagnosis was made after computed tomography of the head revealed left sphenoiditis. Although under treatment, the child manifested meningism during the first day of hospitalization, which subsided the next day. He was treated with ceftriaxone plus clindamycin and had a good outcome, without compli- cations or neurological sequelae.

Highlights

The sphenoid sinus is often referred to as the “neglected” sinus. [1] Infection usually occurs in conjunction with infection of the other paranasal sinuses
We report a case of a previously healthy 4 year old boy, whose sole symptom at presentation was drowsiness
(4) It merits particular concern, due to potentially serious and even fatal complications. [2, 5,6,7,8] It is frequently misdiagnosed because of its atypical presentation. [3,9,10] We report a case of a previously healthy 4-year-old boy, presenting with drowsiness

Summary

Introduction

The sphenoid sinus is often referred to as the “neglected” sinus. [1] Infection usually occurs in conjunction with infection of the other paranasal sinuses. A 4-year-old boy, presented to hospital with somnolence, noticed during the course of the morning despite having slept normally. He had no fever and no signs of infection, nor any history of trauma. Computed tomography (CT) of the head revealed left sphenoid sinus opacity, with the rest of the sinuses and brain (figure 1) normal. The patient commenced treatment with i.v. ceftriaxone plus clindamycin Some hours later, he manifested symptoms indicating meningitis (intense headache, photophobia, emesis and neck stiffness). The day, the meningism subsided, and the rest of his course was uneventful He was treated with intravenous antibiotics for 10 days, after which he was switched to oral cefuroxime axetil for 10 days.

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