A 65-year-old female patient with no relevant past medical history was referred from another center diagnosed with periorbital colitis treated with cecoline and Dacortin®, which had worsened with fever and obnubilation.
On physical examination she had a fever of 39o, neck pain and vomiting, Glasgow 13/15 (mobility of the 4 limbs, spontaneous eye opening).
Blood tests revealed leukocytosis.
At the local level, the patient presented with a subcutaneous adrenal abscess, which was drained.
In the intraoral examination a total maxillary edentulism rehabilitated with osteoposed implants was found, one of them (at the level of upper right maxilla) with mobility and discomfort to palpation.
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Computed tomography showed a right pansinusitis with fistulization of the epidural space that had provoked certis, without signs of intracranial hypertension.
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The patient was admitted to the ICU, and treatment with meropenem and dexamethasone was initiated, which resulted in an improvement in clinical and radiological brain involvement on MRI.
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Subsequently, endoscopic sinus permeabilization and removal of the mobile implant were performed.
The patient was discharged after the antibiotic treatment.
