A 9-year-old 8-month-old male with no relevant past medical history was referred to the Pediatric Emergency Department from his primary care centre for headache and proptosis.
The onset of symptoms 4 days before, such as fever, vomiting, headache and nasal congestion; he was diagnosed with sinusitis at his health center and on antibiotic treatment with amoxicillin-clavulanic acid for 48 hours without improvement of symptoms.
She complained of severe right frontotemporal headache and right eyelid edema that developed into proptosis in the last hours.
Physical examination revealed slight proptosis of the right eye, with mild swelling of the nasal cavity on the same side.
Neurological examination only revealed mild difficulty in conjugated gaze.
Given the poor clinical course of sinusitis and the appearance of neurological symptoms, an emergency skull CT is performed with the clinical suspicion of possible intracranial complications.
CT scan showed pansinusitis, a subperitic phlegmon in the medial wall of the right orbit and a small right frontal subdural empyema (1.8 x 1.8 x 0.6 cm).
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Assessed jointly with professionals of the Neurosurgery Service, it was decided to maintain an expectant attitude.
Empirical intravenous treatment with cefoxime, vancomycin and metronidazole was started.
Likewise, drainage of the primary focus (pansinusitis) was performed performing a sinus evacuation through a nasal approach.
All cultures were negative.
The clinical evolution is favorable, with disappearance of symptoms a few days after the beginning of treatment.
Serial imaging (MRI) controls are being performed, showing progressive decrease until complete disappearance after 18 days of treatment.
Blood tests showed normalization of infectious parameters, with leukopenia and hypertransaminasemia secondary to antibiotic treatment.
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Antibiotic treatment was suspended twenty-six days after the beginning, and the patient was discharged.
Subsequently, it is controlled on an outpatient basis, without evidence of neurological sequelae, and with absolute normalization of analytical parameters.
