Septic shock and death due to occult sinusitis

Abstract

We report a case of septicaemia and death due to occult sinusitis in an otherwise healthy adult. Septicaemia was diagnosed on clinical grounds and blood culture grew Streptococcus pneumoniae. Maxillary sinusitis was discovered incidentally on a CT scan four days after the onset of symptoms. A sinus wash-out revealed pus which on culture was positive for Streptococcus pneumoniae. The patient deteriorated gradually and died despite appropriate therapy. We conclude that sinusitis should be suspected in any case of septicaemia where the primary focus is not known and the patient does not respond quickly to treatment.

Toxic Shock Syndrome and Rhinosinusitis in Children

“…The association between TSS and rhinosinusitis has been less well characterized in the literature, with only a few case reports having been published to date. [3][4][5][6][7][8] The criteria for the diagnosis of TSS were originally established by the Centers for Disease Control and Prevention and were subsequently revised by Reingold et al 9 in 1982. Reingold and colleagues' algorithm for diagnosis stipulates that 4 of 4 diagnostic cri-teria must be present for proven TSS and that 3 of 4 diagnostic criteria must be present for probable TSS ( Table 1).…”

“…1,10 Streptococcus pneumoniae and Streptococcus pyogenes have also been reported as potential causes of TSS, 3 cases of which were described in patients with rhinosinusitis. 4,5,7,11 The clinical course of TSS in most cases is a fulminant one, requiring pressor support and fluid resuscitation for cardiovascular collapse. The mortality rate of TSS is reported to be less than 3% for staphylococcal infections and anywhere from 30% to 70% for streptococcal infections.…”

Pneumococcal Bacteremia Complicated by Hemophagocytic Lymphohistiocytosis

“…The absence of sinus symptoms in this case was unusual, although occult sinusitis has previously been reported as the etiology of severe sepsis and pneumococcal bacteremia in a healthy adult. 13 More commonly, sinusitis presents without localizing symptoms in the intensive care unit (ICU), due to difficulty in communication with intubated patients, the placement of nasogastric feeding tubes, and lack of normal sinus clearance reflexes. 14 Antimicrobial therapy is the cornerstone of treatment for bacterial sinusitis, with surgical intervention reserved for local extension of disease, refractory infection, or recurrent episodes of sinusitis.…”