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Malaysian Family Physician : the... Jul 2021Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled...
Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a "string of pearls" present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally. A middle-aged gentleman presented with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. A high index of suspicion is required for early diagnosis of fungal endophthalmitis.
PubMed: 34386173
DOI: 10.51866/cr1100 -
BMJ Case Reports Oct 2021We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and...
We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew , a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.
Topics: Brain Ischemia; Female; Humans; Ischemic Stroke; Middle Aged; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed
PubMed: 34607813
DOI: 10.1136/bcr-2021-242943 -
Radiation Oncology (London, England) Sep 2023To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the...
OBJECTIVE
To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients.
PATIENTS AND METHODS
A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS.
RESULTS
(1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040).
CONCLUSION
(1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.
Topics: Humans; Nasopharyngeal Carcinoma; Retrospective Studies; Sinusitis; Magnetic Resonance Imaging; Nasopharyngeal Neoplasms
PubMed: 37723540
DOI: 10.1186/s13014-023-02331-3 -
Pituitary Dec 2017There is a high incidence of abnormal sphenoid sinus changes in patients with pituitary apoplexy (PA). Their pathophysiology is currently unexplored and may reflect an...
PURPOSE
There is a high incidence of abnormal sphenoid sinus changes in patients with pituitary apoplexy (PA). Their pathophysiology is currently unexplored and may reflect an inflammatory or infective process. In this preliminary study, we characterised the microbiota of sphenoid sinus mucosa in patients with PA and compared findings to a control group of surgically treated non-functioning pituitary adenomas (NFPAs).
METHODS
In this prospective observational study of patients undergoing trans-sphenoidal surgery for PA or NFPA, sphenoid sinus mucosal specimens were microbiologically profiled through PCR-cloning of the 16S rRNA gene.
RESULTS
Ten patients (five with PA and five with NFPAs) with a mean age of 51 years (range 23-71) were included. Differences in the sphenoid sinus microbiota of the PA and NFPA groups were observed. Four PA patients harboured Enterobacteriaceae (Enterobacter spp., N = 3; Escherichia coli, N = 1). In contrast, patients with NFPAs had a sinus microbiota more representative of health, including Staphylococcus epidermidis (N = 2) or Corynebacterium spp. (N = 2).
CONCLUSIONS
PA may be associated with an abnormal sphenoid sinus microbiota that is similar to that seen in patients with sphenoid sinusitis.
Topics: Adult; Aged; Female; Humans; Male; Microbiota; Middle Aged; Pituitary Apoplexy; Pituitary Neoplasms; Prospective Studies; Sphenoid Sinus; Young Adult
PubMed: 28853001
DOI: 10.1007/s11102-017-0823-9 -
Cureus May 2022Cavernous sinus thrombophlebitis is a rare, potentially life-threatening, condition that is most often caused by gram-negative bacteria and, to a lesser extent, fungi....
Cavernous sinus thrombophlebitis is a rare, potentially life-threatening, condition that is most often caused by gram-negative bacteria and, to a lesser extent, fungi. is an opportunistic fungus that frequently affects patients with a weak immune system. We describe a case of an adult female without diabetes who developed sphenoid sinusitis causing cavernous sinus thrombophlebitis. The patient presented with headache, diplopia, and right lateral rectus palsy. Cranial magnetic resonance imaging (MRI) showed abnormal prominent enhancement involving the cavernous sinuses associated with interspersed internal non-enhancing components indicating bilateral cavernous sinus thrombophlebitis and exuberant inspissated secretions within the left sphenoid sinus. After administering enoxaparin and intravenous antibiotics, the patient underwent endoscopic transnasal sphenoidotomy with nasal polypectomy. Culture results showed growth of mucor, for which the patient received itraconazole. Thereafter, complete resolution of headache, diplopia, and right lateral rectus palsy was observed. On follow-up, no residual neurologic deficits were noted. The repeat cranial MRI showed no abnormality involving the cavernous sinuses, with no evidence of cavernous sinus thrombophlebitis and normal paranasal sinuses. While a few case reports have been available on cavernous sinus thrombophlebitis caused by fungal sphenoid sinusitis with as the primary organism, none have involved immunocompetent individuals.
PubMed: 35719783
DOI: 10.7759/cureus.25034 -
International Journal of Surgery Case... Jul 2024Fungal sphenoiditis is a rare case in clinical practice. Usually affecting just one sinus, Aspergillus is the most common cause of fungal sinusitis. Atypical headache...
INTRODUCTION
Fungal sphenoiditis is a rare case in clinical practice. Usually affecting just one sinus, Aspergillus is the most common cause of fungal sinusitis. Atypical headache with unresponsive to analgetics is one of symptom from Isolated Sphenoid sinusitis.
CASE REPORT
This case report presents a 37 year old female with isolated sphenoiditis fungal. The patient came with atypical headache as the major symptom.
CLINICAL DISCUSSION
Based on the morphology of the sphenoid sinus and its surrounding structures, diagnosis is often challenging.
CONCLUSION
After some medicine, the chief complaint did not disappear. A functional endoscopic sinus surgery was performed to remove the fungal ball, and the patient get good result.
PubMed: 38823230
DOI: 10.1016/j.ijscr.2024.109838 -
Cureus Mar 2022Background and objective Knowledge about sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to...
Background and objective Knowledge about sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to avoid serious complications like postoperative meningitis, sinusitis, cerebrospinal fluid (CSF) rhinorrhea, and intracranial hematoma. In this study, we aimed to assess the proportion of anatomical variants in sphenoid sinus pneumatization and to determine the common sphenoid pneumatization pattern in a South Indian population. Methods This retrospective study was conducted over a period of six months from July 2019 to December 2019 among 573 patients who underwent non-contrast CT (NCCT) or contrast-enhanced CT (CECT) of the brain, paranasal sinuses (PNS), orbit, and face. Results Most of the patients were in the age group of 20-39 years. The male-to-female ratio was 2.45:1. Among the posterior extensions, the most common variant was type D, followed by type C, type B, and type A. Among the clival extensions, the most common variant was Cliv-A, followed by Cliv-B, Cliv-C, and Cliv-D. The most common lateral wall pneumatization was bilateral lateral wall pneumatization followed by unilateral sinus wall pneumatization. Lat-A was the most common lateral wall pneumatization pattern followed by Lat-D, Lat-B, and Lat-C. Conclusion Our study intends to classify the sphenoid sinus pneumatization pattern and identify the most common variant among them, thereby guiding the skull base and FESS surgeons in choosing the correct mode of the operative procedure and also anticipating and avoiding complications of surgery.
PubMed: 35433147
DOI: 10.7759/cureus.23174 -
European Annals of Otorhinolaryngology,... Apr 2016Nocardia sinusitis is exceptional, as a Medline search revealed only one published case. The authors report a case of sphenoid sinusitis complicated by infratemporal...
INTRODUCTION
Nocardia sinusitis is exceptional, as a Medline search revealed only one published case. The authors report a case of sphenoid sinusitis complicated by infratemporal fossa abscess, which raised several diagnostic problems.
CASE REPORT
The patient was referred with temporal headache, subacute trigeminal neuralgia and subsequent infectious syndrome. Computed tomography imaging revealed left sphenoid sinusitis with osteolysis and infratemporal fossa abscess, as well as suspicious lung nodules suggestive of the initial site of infection. Bacteriological specimens obtained by endoscopic sphenoidotomy confirmed the presence of Nocardia nova. A favourable outcome was observed in response to targeted antibiotic therapy.
DISCUSSION AND CONCLUSION
Sphenoid sinusitis with infratemporal fossa abscess is an exceptional mode of presentation of nocardiosis, illustrating the polymorphic clinical features of this disease. Bacteriological examination of samples taken directly from the organ concerned, in this case, by sphenoidotomy, is the only formal diagnostic criterion. Antibiotic therapy with intravenous imipenem/amikacin, followed by oral sulfamethoxazole/trimethoprim (Bactrim Forte(®)) for several months, is the key to successful management.
Topics: Abscess; Aged; Female; Humans; Nocardia Infections; Sphenoid Sinusitis
PubMed: 26471040
DOI: 10.1016/j.anorl.2015.09.004 -
Clinical and Experimental... Sep 2014This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival.
OBJECTIVE
This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival.
METHODS
A retrospective review of 12 cases of invasive fungal sphenoiditis was conducted.
RESULTS
Cases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027).
CONCLUSION
The survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.
PubMed: 25177433
DOI: 10.3342/ceo.2014.7.3.181 -
SAGE Open Medical Case Reports 2022Isolated sphenoid sinus disease (ISSD) is an uncommon entity and may present with non-specific symptoms. As sphenoid sinus is located adjacent to vital structures, a...
Isolated sphenoid sinus disease (ISSD) is an uncommon entity and may present with non-specific symptoms. As sphenoid sinus is located adjacent to vital structures, a diseased sphenoid sinus can potentially lead to devastating complications such as cranial neuropathies, cavernous sinus thrombosis and intracranial abscess. Herein, we report a case series of three patients who presented with different localization of headache as their main symptom. Endoscopic nasal assessment showed abnormal nasal cavity findings with mucosal thickening and soft tissue mass occupying the sphenoid sinus revealed by computed tomography (CT) scan. All the sphenoid sinuses were drained via endoscopic approach. Post operatively, antibiotics or anti-fungal were given, however, these three cases displayed the possible variation in severity of this disease. Case 1 had an uncomplicated inflammatory disease of the sphenoid sinus, which is of bacterial origin, while the other two cases had fungal infection. Case 2 achieved disease stability with anti-fungal treatment, but Case 3 had a serious complication after treatment with permanent vision loss. A patient who presents with atypical headache, not responsive to analgesia should be investigated promptly with nasal endoscopic examination and radiological imaging for isolated sphenoid sinus disease to avoid devastating complications.
PubMed: 35646372
DOI: 10.1177/2050313X221097757