Bilateral cavernous sinus thrombosis by Zygomycetes and Enterococcus

• Main Author: Matos, Ricardo
• Publication Date: 2019
• Other Authors: Sousa, Mafalda, Marques, Pedro, Vales, Fernando, Santos, Margarida
• Format: Article
• Language: por
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://doi.org/10.34631/sporl.749
• topic: Acute rhinosinuitis; cavernous sinus thrombosis; endoscopic sinus surgery; Rinossinusite aguda; trombose do seio cavernoso; cirurgia endoscópica nasossinusal

We present a case of acute rhinosinusitis complicated with bilateral thrombosis of the cavernous sinus in the adult, aim to alert to its clinical presentation and need for a high index of suspicion. We describe a 53-year-old man presenting with cough and rhinorrhea, with 15 days of evolution, followed by holocranial pulsatile headache, refractory to analgesia, as well as a paresis of the left abducens nerve. After contrastenhanced computed tomography of the cranio-encephalic structures and paranasal sinuses, complete opacification of every right paranasal sinus, associated with erosion of the cribriform plate, bilateral solution of continuity in the para-sphenoidal bone region, and filling defects within the cavernous sinuses were observed, suggesting bilateral cavernous sinuses thrombosis. After endoscopic sinus surgery and directed antibiotic treatment, a good clinical, analytical and imaging evolution were observed, and no neurological sequelae were present.