Subclinical chronic sinusitis causing presumed ventriculoperitoneal shunt sepsis in a child

Abstract

Rhinosinusitis is often under diagnosed and overlooked in children. Fever as the only symptom of rhinosinusitis is rare and largely unreported. A three-year-old boy with a right frontal ventriculo-peritoneal (VP) shunt for congenital hydrocephalus presented with a three-month history of recurrent high grade intermittent fever. He had no other symptoms. A cranial Computed Tomogram for VP shunt evaluation revealed isodense lesions filling the right and left ethmoidal and maxillary sinuses. Bilateral inferior meatal puncture revealed frank pus in both maxillary sinuses. Microbacterial culture yielded Streptococcus pyogenes sensitive to Erythromycin. Following treatment, fever subsided and remained so in subsequent outpatients’ visits.