LEFT PANSINUSOPATHY COMPLICATED WITH SUBDURAL EMPYEMA AND INTRACRANIAL ABSCESS: A CASE REPORT IN PEDIATRICS

Abstract

Acute bacterial sinusitis (ABS) is frequent in the pediatric population, usually with a self-limiting course. However, intracranial complications, although rare, present high morbidity and mortality and frequently result in permanent neurological sequelae. Inadequate initial diagnosis can significantly compromise the prognosis. Case Presentation: A 10-year-old female pediatric patient, with a history of obesity, presented with an initial picture of productive cough, rhinorrhea, fever, headache, and left periorbital edema. The initial incorrect diagnosis of bacterial conjunctivitis resulted in the prescription of ophthalmic eye drops, delaying appropriate systemic antimicrobial treatment for 11 days. Main Clinical Findings: Transferred to a neurological referral service presenting with progressive decrease in level of consciousness (Glasgow Coma Scale - GCS: 12), dysarthria, and paraplegia. Further investigation revealed meningoencephalitis, left pansinusitis with erosion of the cribriform plate, subdural empyema, and frontobasal hypodensity compatible with a brain abscess. Therapeutic Interventions and Evolution: The patient received prolonged parenteral antibiotic therapy for 12 weeks (ceftriaxone 2g every 12 hours, metronidazole 500mg every 8 hours, vancomycin 15mg/kg every 8-12 hours) and triple anticonvulsant therapy (phenytoin, topiramate, and phenobarbital) after developing status epilepticus on the third day of hospitalization. She underwent decompressive craniectomy with drainage of subdural empyema. Outcome: Hospital discharge after 84 days of hospitalization with significant neurological sequelae: right hemiplegia, dysarthria, and structural epilepsy, stable on anticonvulsant medication. Referred for multidisciplinary rehabilitation. Conclusions: This case illustrates the importance of early recognition of warning signs in pediatric bacterial sinusitis, particularly the need to reassess patients who do not progress as expected. Periorbital edema with systemic symptoms should be considered an emergency until proven otherwise. The delay in diagnosis resulted in progression to multiple simultaneous intracranial complications, highlighting that early detection is critical to improving neurological outcomes.