Tsunami sinusitis

Abstract

On Friday March 11, 2011, an earthquake and giant tsunami struck the Japanese Pacific coast, killing more than 10 000 people. 1 National Police Agency of JapanDamage Situation and Police Countermeasures associated with 2011 Tohoku district—off the Pacific Ocean Earthquake. http://www.npa.go.jp/archive/keibi/biki/higaijokyo_e.pdf Google Scholar A 31-year-old woman was brought to our hospital a week after the disaster for the treatment of trauma. She had inhaled seawater and nearly drowned. On arrival, she had severe pneumonia and multiple injuries, including a laceration to the top of her foot and a fracture of the thoracic spine. CT of the head showed fluid and opaque material in the maxillary and sphenoid sinuses (figure A, left). Despite treatment with intravenous tazobactam/piperacillin and gentamicin and the subsequent improvement of her pneumonia, she had a persistent fever and her C-reactive protein (CRP) concentration was high at 100 mg/L within 1 week. She underwent irrigation of maxillary sinuses bilaterally under local anaesthesia, during which green-coloured purulent material and sand were washed out (figure B, left). Because of her poor general condition, only the maxillary sinuses could be irrigated. The next day, her temperature decreased; CRP concentration initially fell to 51 mg/L, and then to 7 mg/L 2 weeks later. Culture of the contents of the sinuses showed Pseudomonas aeruginosa, Proteus vulgaris, and Escherichia coli. Given the improvement in her inflammatory indices, we decided to watch her condition carefully without further sinus irrigation.