Unusual presentation of chronic sinusitis with complication in contralateral side in a pediatric patient: ‘A case report’

Rhinosinusitis refers to inflammation of the nasal cavity and paranasal sinuses, which can occasionally extend beyond the sinuses causing serious morbidity. Intracranial and orbital complications remain rare, particularly in children. We report a 12-year-old previously healthy girl who presented with a one-month history of headache and right eye pain, followed by fever, vomiting, right periorbital swelling, diplopia, and photophobia. Examination revealed right periorbital edema, chemosis, and proptosis with normal visual acuity. Computed tomography and magnetic resonance imaging showed left pansinusitis with bilateral sphenoid sinus involvement and skull base erosion complicated by cavernous sinus thrombosis. Acinetobacter iwofii, an uncommon pathogen in pediatric sinusitis, was isolated. Early imaging, appropriate antibiotics and anticoagulation therapy with prompt surgical intervention were crucial in achieving full recovery with no sequalae. Physicians should maintain high index of suspicion and watch for possible occurrence of this rare complication.